-HA

-HB

-Factor XI deficiency

-Factor II deficiency

-Factor V deficiency

-Factor XIII deficiency

-Factor VII deficiency

Dental problems in Hemophilia

-Severe Deficiency (Less than 1%)

-Moderate Deficiency (less than 1%)

-Moderate Deficiency (1%-5%)

-Mild Deficiency (≥ 5%)

Precoagolant classification

-Frequent bleeding

-Two or four per month

-Common sites (Joint , muscle , skin)

-Hemarthrosis

-Chronic muscular problems

-Debilitating painful arthritis

-Knee , elbow , ankle , Hip , shoulder

-Pseudotumor in jaw

-Mouth laceration

Severe deficiency Hemophilia

Hemophilia

Infrequently bleeding

Only surgery or Trauma

Purified concentration factor

Factor through recombinant technology

Whole blood , plasma , cryoprecipitate

Half life factor VIII , IX

Medical Treatment of Hemophilia

(…Continue)Factor VIII concentrate

Routine bleeding (40%)

Mild VIII Deficiency DDAVP

DDAVP Rise of factor VIII Activity/VWF

Tachyphylaxis

Water Retention

Hyponautremia

Seizures

Factor IX deficiency

Purified coagulation factor IX

concentrate

Pure production class protrombine

complex

PCC = factor IX + …

Repeated PCC Infusion DIC

Level factor (40%)

Hemophilia B Treatment

Vonwillbrand disease

Subtyping VWF

DDAVP (VWF)

Other modalities

Inhibitors(28% HA , 3% - 5% )in Severe HB

Low Response Rate to factors

Continue Hemorrhage

Arthritis

Degenerative joint disease

Viral Infection blood borne Infection

AIDS , Hepatitis B,C

Complications factor Infusion

Risks to dental staff

Acquiring hepatitis B,C

Acquiring HIV

Development of a treatment plan in the

hemophilia

Use of anti fibrinolytics ,Dosage

Side effect

Pain control in Hemophilia (…Continue)

Analgesia

Local Anesthesia

PDL Injection

Infiltration

Block Anesthesia

Prevention of Dental Disease

Periodontal therapy

Restorative procedures

Pulp therapy

Oral surgery

Surgical complications

Antibiotic prophylaxis

Orthodontic treatment

Dental Healthcare protocol in hemophilia

The end

Dr . Jabbarifar

2007

Fungal Infection

Viral Infection

Bacterial Infection

Neoplasm's

Idiopathic lesions

HIV-gingivitis , HIV – Periodontitis .

Oral manifestations HIV Infection

The end

Dr . Jabbarifar

2007