Haemophilia

Question 1

Why is it important to know if a patient has a bleeding disorder before starting treatment?

Answer 1

• additional measures required
  
  • haemostatic measures
  • longer bleeding post-op

Question 2

How can pain management differ for haemophiliac patients?

Answer 2

• aspirin
  
  • no under 16s
    
    • Reyes disease
• NSAIDs
  
  • take advice from haemophilia team

Question 3

How can trauma management differ for haemophiliac patients?

Answer 3

• seek advice from haemophilia team

Question 4

What are the management options for patients with different levels of type A haemophilia?

Answer 4

• discuss with local haemophilia centre
• extract one tooth at a time
  
  • observe for 24 hour period
• haemophilia centre
  
  • factor replacement therapy
    
    • before extraction
    • after extractions
• tranexamic acid
  
  • mouth rinse
  • oral form

Question 5

What should be done before proceeding with an extraction in a haemophilia patient?

Answer 5

• check the plasma activity levels
• local haemostatic techniques
  • suturing
  • tranexamic acid mouth rinse
  • packing socket with surgical
  • fibrin glue

Question 6

What is the minimum coagulation factor level required for an invasive procedure?

Answer 6

• general practice
  
  • 100
• hospital
  
  • 50

Question 7

What standard dental tools and techniques have to be taken care with to avoid causing bleeding in haemophilia patients?

Answer 7

• luxators
• probes
• x-ray packets
• aspirator tips
• 3 in 1
• impression

Question 8

How should LA be administered for haemophilia patients?

Answer 8

-no lingal infiltrations

• deliver LA slowly
  
  • fast pulls tissue apart
  • can cause haematoma
• IDB
  
  • risk of trismus

Question 9

What pre-operative steps should be taken before extractions in haemophilia patients?

Answer 9

• good oral hygiene
  
  • less inflammation
  • less bleeding
• tranexamix acid tablets

Question 10

What peri-operative steps should be taken for extractions in haemophilia patients?

Answer 10

• tranexamic rinse
• atraumatic extraction
  
  • minimal trauma
  • do not break roots
• suture
• surgicel

Question 11

What post-operative steps should be taken for extractions in haemophilia patients?

Answer 11

• do not disturb socket
  
  • do not brush site for 24 hours
• no extreme physical exertion
• no mouth rinsing
  
  • 24 hours
  • later can rinse with salt water
• do not eat until numbness worn off
  
  • risk of cheek and lip biting
• bite and damp gauze
  
  • phone haemophilia centre
  • review
    
    • check surgicel and sutures

Question 12

Why might bleeding increase if the patient is nervous?

Answer 12

• blood pressure increases
  
  • nervous
  • in pain
• explain what is going on
  
  • noises
  • pushing and pressure
  • push probe into PDL, pressure not pain