Special Circumstance Extractions

Question 0

What factors may predispose a patient to a bleing disorder?

Answer 0

Bleeding diathesis - underlying bleeding disorder
Therapeutically anticoagulat patients
Antiplatelet medications
Side effect of medications prescribed

Question 1

What are some instances in which the management of patients requiring extractions is modified by their medical status?

Answer 1

Excessive bleeding
Endocarditis
BAORJ
Osteoradionecrosis of the jaws

Question 2

What should be investigated with regards to anticoagulated patients?

Answer 2

What medications are they taking?
Ab prophylaxis required?
Are they in the correct therapeutic range for the drug?

Question 3

What are examples of anticoagulants and antiplatelet drugs?

Answer 3

Anticoagulant:
Dicoumadin (Warfarin)
Antiplatelet:
Aspirin
Clopidogrol (iscover and plavix)

Question 4

How should a patient on warfirin be managed?

Answer 4

An IRN test should be obtained.
1 is normal
Less than 2 is subtherapeutic
2-4 is therapeutic
If more than 4.5 patinet is at risk of spontaneous bleeding (back to medical practitioner asap)
Can interact with metronidazole

Question 5

How should tranexamic acid be applied post extraction?

Answer 5

Socket irrigated and rins with tranexamic acid
Piece of resorbable haemostatic foam soaked in tranexamic acid is then tigghtly packe into the socket
Socket sutured with resorbable suture