Special care - revision notes Flashcards
What is warfarin
warfarin is a Vit K antagonsit that works by blocking the clottiginfactors essential for forming a clot.
These are clotting factors , 2, 7, 9, 10 and protein C and S
INR
international normalised ratio - measures the time for the blood to form a clot
Prothrombin time/referecne partial thromboplasatin time
PT is esseintial for forming a clot
INR for healhty people
= 1
INR for people on warfarin recienving tx
INR <4 and stable
Stable INR
<4 and has been for the last 2 months
does not require weekly monitoring
Stable INR
tests 72 hrs before the procedure
Why are people on warfarin
Atriral fibrilliation
MI
Blood clots in veins (venous thrombosis)
Blood clots in lungs (pulmonary embolism)
Low risk dental procedures
6PPC
examination
radiographs
simple XLA
RSD
direct resotrations
High risk dental procedures
Biopsies
Rasing flaps
Gingivectomy
Extensive or complicated XLA’s
Apixiban
a direct noval oral anticogulatn that works by inhibting factor Xa which works by blocking the action of activated factor xwhich is needed for forming a clot
taken x2 daily
Dabagratran
a direct inhibotr of the factor thrombin
taken x2 daily
Rivaroxaban
taken once daily
Apixaiban and dabagratran
delay morning does till haemostasis has been achied >4hrs after tx
Treatment if on warfarin
> 4 then delay treatment
early morning and week appts
haemostasiis agents ready
XLA no more than 3 teeth at one time
paracetamol instead of NSAIDs
Thrombin
convereted from prothrombin
serine protease
thrombin then converts fibrnogen to fibrin
Cogualtion casacade
for a clot to form need to activate proteins called clotting factos
- intrinsic - activated by factors in the blood (factor VII)
- extrinsic - activated by factors in the tissues
common - both theses pathways results in the activation of the common and facto X which converts fibrnogen to fibirn to form a clot
MDT for head and neck cancer
oncologist
chemo nurse
speech and language therapsit
physio
patholoigist
surgeon
speacial care dentist
Risk factors for oral cancer
smoking
acohol
betal quid
nutrtion - low in antioxidantes
Socieconmic factors
poor OH and dental health
HPV
High risk sites for oral cancer
ventral and lateral borders of tongue
buccal mucosa
floor of mouth
hard and soft palate
orpharynx
Signs and sympomts
horseness in voice
persient ulcer with unknown casues for >3wks
red or white patches in mouth >3weeks
ear pain with no ear abnormalities >3wks
persistent soreness
unexpailed lump >3wks
Clinical signs of oral cancer
solitary ulcer
raised with rolled margins
firm base and hard
erythema
Pre malgingant conditions
Leukoplakia
erythroplakia
lichen planus
palatal keratosis
squamous cell carcinoma
submucosous fibrosis
Mucosistis
inflammation and ulceration leading to pain
7-14 days after drug therapy
tx for mucositis
avoid spicy acidic food, spirits and tea
smoking avoid
soidium bicarb, tea tree oil , honey, CHX, gelclair, saline
chew on ice cubes
oral cooling ice
morphine/;laser light therapy