Patient care perio and bleeding Flashcards
1
Q
what are some major factors to bleeding problems?
A
- smoking and alcohol
- high sugary diets
- also patient history should be carefully taken to the sight
2
Q
name the haematological disorders we may come across
A
- anaemia
- neutropenia
- leukaemia
- lymphoma
- disorders of platelets and coagulation
3
Q
what is anaemia and what are the dental findings
A
low Hb for age/ethnicity/gender
- angular cheilitis
- recurrent oral ulceration
- candidiasis (white membrane)
- glottis (tongue change)
- burning mouth syndrome
- mucosal parlour (paleness)
4
Q
what is neutropenia
A
low conc. of neutrophils
- recurrent oral ulcerations
- candidiasis
- herpes
- neutropenic ulcerations
5
Q
what is leukaemia
A
cancer of blood-producing tissues
- bleeding
- anaemia
- gingival swelling
- ulcer
- infections
6
Q
what is lymphoma
A
cancer of the lymphatic system
- Hodgkin: often begin in the neck
- non-Hodgkin: painless enlarged cervical nodes, infections and ulcerations
7
Q
what are some disorder of platelets and coagulation
A
acquired
- liver and renal disease
- thrombocytopenia
- medications
inherited
- platelets functions
- von Willebrand disease
- haemophilia A (factor VIII) and B (factor XI) males only
8
Q
how would you manage a patient who has known bleeding disorders?
A
- treat first thing in the morning
- avoid invasive procedures
- generally, teeth will erupt and exfoliate without problems
- lookup BNF for drug side effects and interactions
9
Q
Idiopathic thrombocytopenic purpura
A
- autoimmune platelet destruction
- prolonged bleeding
- treatment: steroid and immunosuppressants
- avoid regional blockers or anything which may damage platelets (eg. aspirin, NSAID’s)
10
Q
what if you are suspicious of Idiopathic thrombocytopenic purpura
A
- get advice and refer immediately
- follow up on the referral with a letter or phone call
11
Q
should we pause the medication for dental treatment?
A
- risk of bleeding complications during dental treatment if the patient continues with the medications should be compared with thrombotic events if the patient’s medication is stopped.
- if the patient is taking warfarin or vitamin K antagonist with INR below 4, treatment should be done without interrupting medications
12
Q
what is the advice for patients who are NOAC’s (Novel oral anticoagulant)
A
- low risk of bleeding in dental treatment: treat w/o interrupting the medications
- high risk of bleeding in dental treatment: advice the patient to miss/delay their morning dose, on the day of the treatment
