hand book for dental surgeons - Indian Dental Association ...

31
Visit: http://image.idakunnamkulam.com/
Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders
The problem of dental extractions is a difficult one in hemophiliacs. Without proper premedication, even
a minor surgical procedure may result in death from exsanguination. tooth extraction by means of rubber bands
has often been used successfully, the rubber band being placed around the cervix of the tooth a nd allowed to
migrate apically, causing exfoliation of the tooth through pressure necrosis of the periodontal ligament.
Laboratory Findings. The characteristic defect of hemophilia is a prolonged coagulation time.
the bleeding time is normal, as is the prothombin time and platelet agregation. In vitro, the deficiency of the
clot-prompting factor in the plasma of hemophiliacs impairs clotting because it appears to retard development
of the substance responsible for conversion of prothrombin to thrombin. Separation of the various forms of
hemophilia and proper diagnosis depends upon demonstration that the plasma of a patient with a known form of
hemophilia does not correct the plasma clotting defect in the patient under observation.
Treatment and Prognosis. There is no known cure for hemophilia. the affected persons should be
protected from traumatic injuries.
If a surgical procedure such as tooth extraction must be carried out, the operation should be considered a
major one and performed only in a hospital.
The greatest numbers of fatalities in hemophiliacs have resulted from surgical procedures, including
tooth extraction. Preoperative transfusion of whole blood and the administration of antihemophilic factor
concentrate are recommended. Nevertheless, oral surgery is a dangerous procedure and should be avoided
whenever possible. Unfotunately, a small percentage of hemophiliacs have circulating anti-coagulant, probably
an antibody, which specifically inactivates hemophilic factor, negating the effects of transfusion.
The prognosis is variable, and many affected persons die during childhood.
Visit : http://image.idakunnamkulam.com/
Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders