Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Guidelines for Dental Extractions, Dental Restorations and Orthodontic Procedures • Permanent molars and wisdom teeth • VWD: ~ One hour prior to extraction in patients with type 1 VWD who have a desmopressin (DDAVP) response to 50-60%, give desmopressin (DDAVP), IN or IV ~ One hour prior to extraction in type 1 VWD non-responders, type 2 or 3 VWD, give VWF/FVIII concentrate to raise VWF:RCo and factor VIII to 50-60% ~ 24 hours post extraction in patients with type 2 or type 3 VWD, repeat infusion of VWF/FVIII concentrate to raise VWF:RCo and FVIII:C to 40-50%; no 24 hour treatment for patients with mild VWD who respond to desmopressin • Hemophilia A: ~ One hour prior to extraction in patients with mild hemophilia who have a desmopressin response to 50-60%, give desmopressin (DDAVP), IN or IV ~ One hour prior to extraction in patients with moderate or severe hemophilia A and mild hemophilia A desmopressin nonresponders, give factor VIII concentrate to raise factor VIII to 80100% ~ 24 hours post extraction in patients with moderate or severe hemophilia A, give factor VIII concentrate to raise factor VIII 6080 %; 24 hour treatment for patients with mild hemophilia A who respond to desmopressin – repeat DDAVP • Hemophilia B: ~ One hour prior to extraction, give factor IX concentrate to raise factor IX level to 60-80% 24 hours post extraction, give factor IX concentrate to raise factor IX level to 40-60%; no additional treatment for mild hemophilia B • • All patients: Antifibrinolytic for 3-7 days or until healed; may use injectable Amicar as a mouthwash in older children and adults Deciduous Teeth: • Local measures to obtain hemostasis such as avatene, topical thrombin, packing with Surgicel • If bleeding around loose deciduous tooth, extract the tooth • Antifibrinolytic for 2-4 days until healed; may use injectable Amicar or tranexamic acid as a mouthwash in older children and adults • If bleeding occurs in spite of local measures and antifibrinolytics, treat with DDAVP or replacement therapy as recommended above 2 • Nerve Block for Dental Restorations: • VWD and mild hemophilia A patients who respond to desmopressin as above, give desmopressin ~ one hour prior to the procedure • VWD non-responders, type 2 and type 3 VWD, ~ one hour to the procedure, give VWF/FVIII concentrate to raise the VWF and FVIII levels to 40-50% • Moderate and severe hemophilia A, ~ one hour prior to the infusion, give factor VIII concentrate to raise the factor VIII level to 40-50% • Hemophilia B, ~ one hour prior to the procedure, give factor IX concentrate to raise the factor IX level to 30-40% • Orthodontic Procedures: • Discuss procedure with oral surgeon/orthodontist to determine if gingival damage/nerve blocks/extractions are anticipated and treat as recommended above; in general, if no nerve block or extractions are planned, pretreatment is not necessary • If gingival bleeding occurs, local measures are generally sufficient and antifibrinolytic therapy can be given for several days until the area is healed • Antifibrinolytic Therapy • Systemic: Amicar (elixir of 1.25 m/5cc or tablets of 500 or 1000 mg), 50 mg/kg/dose (maximum 3 grams), PO, q 6 hours; when tranexamic acid becomes available (500 mg tablets), give 25 mg/kg/dose TID or QID • Mouthwash: Injectable Amicar (1.25 gm/5 cc) – swish 10 cc gently over extraction site for 1-2 minutes and then expectorate; nothing to eat or drink for 1 hour after dose Revised 5/2008