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Kelkar M, Kadanthode M, Mohanty S, Verma A. Effect of low-level laser therapy on post-extraction hemostasis in patients with hemophilia - A prospective cohort study. J Craniomaxillofac Surg 2023:S1010-5182(23)00074-4. [PMID: 37355374 DOI: 10.1016/j.jcms.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 02/15/2023] [Accepted: 05/21/2023] [Indexed: 06/26/2023] Open
Abstract
Dental extraction in hemophiliacs can be complicated by perilous bleeding. Although developments in local hemostatics and factor replacement have made outpatient extraction feasible, there is no standard protocol for preventing hemorrhagic exigency. Low-level laser therapy (LLLT) has firmly established role in hemostasis due to its ability to seal vessels, but this function has not been conclusively established in hemophiliac patients. The objective of our study was to evaluate the effectiveness of LLLT as compared with the standard protocol alone in achieving post-extraction hemostasis. A prospective interventional cohort study was designed and consisted of 60 patients with hemophilia A or B, who reported to the Maulana Azad Institute of Dental Sciences, New Delhi between October 2021 and March 2022. These were divided equally into test and control groups, both following the standard protocol. In the test group, extraction sockets were exposed to LLLT. The study assessed time required, instance of rebleeding, and additional methods employed for hemostasis in each group. The results showed a 22.42% reduction in average time taken to achieve hemostasis in the test group as compared with the control group. The tranexamic acid pack was replaced in two cases in both groups after 60 min of procedure. Three cases in the control group required suturing, and one case required cauterization. Rebleeding occurred in four cases in the test group and in 13 cases among the controls. Postoperative factor was infused in three and 12 cases in the test and control groups, respectively. The authors believe that perioperative use of LLLT should be encouraged because it demonstrated a significantly reduced time for hemostasis among hemophilia patients.
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Affiliation(s)
- Monica Kelkar
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, New Delhi, India
| | - Mithilesh Kadanthode
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, New Delhi, India.
| | - Sujata Mohanty
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, New Delhi, India
| | - Anjali Verma
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, New Delhi, India
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Desai S, Berry EJ, Unkel JH, Reinhartz J, Reinhartz D. A case report of haemophilia: a review of haemophilia and oral health implications. Br Dent J 2023; 234:92-95. [PMID: 36707573 DOI: 10.1038/s41415-023-5448-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/09/2022] [Indexed: 01/29/2023]
Abstract
Haemophilia is an inherited haematological disorder that can result in prolonged bleeding in patients. Dental procedures such as extractions and periodontal surgery can be associated with post-operative bleeding; therefore, patients with the diagnosis of haemophilia must have proper medical management. In this article, we aim to illustrate the importance of: having the appropriate knowledge to manage a patient with haemophilia suspected by the dental team; the need for proper medical management; and referral of patients with symptoms of a bleeding disorder.
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Affiliation(s)
- Shreya Desai
- Paediatric Dental Resident, Bon Secours St Mary´s Hospital Program for Advanced Paediatric Dental Education, 6900 Forest Ave, Suite 110, Richmond, Virginia, 23230, USA
| | - Elizabeth J Berry
- Research Course Director, Bon Secours St Mary´s Hospital Program for Advanced Paediatric Dental Education, 6900 Forest Ave, Suite 110, Richmond, Virginia, 23230, USA.
| | - John H Unkel
- Director of Paediatric Dentistry, Bon Secours St Mary´s Hospital Program for Advanced Paediatric Dental Education, 6900 Forest Ave, Suite 110, Richmond, Virginia, 23230, USA
| | - Judy Reinhartz
- Co-Research Coordinator, Bon Secours St Mary´s Hospital Program for Advanced Paediatric Dental Education, 6900 Forest Ave, Suite 110, Richmond, Virginia, 23230, USA
| | - Dennis Reinhartz
- Co-Research Coordinator, Bon Secours St Mary´s Hospital Program for Advanced Paediatric Dental Education, 6900 Forest Ave, Suite 110, Richmond, Virginia, 23230, USA
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Ramos EA, Diamante M, Caruso D, Muiño JM, Baques A, Antonelli LB, Gutierrez J, Minigutti MO, Guerrero G. Outpatient minor oral surgery in patients with hemophilia: A case series of 23 patients. J Clin Exp Dent 2019; 11:e395-e399. [PMID: 31110621 PMCID: PMC6522108 DOI: 10.4317/jced.55506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/06/2019] [Indexed: 11/06/2022] Open
Abstract
Hemophilia is an inherited coagulation disorder characterized by deficiency of the coagulation factor VIII or IX. When the management of hemostasis is inadequate, these patients are at high risk of experiencing intra and postoperative bleedings after tooth extractions. Coagulation factor replacement therapy allows performing most surgical procedures safely, although the factor levels and length of treatment have not been clearly determined. In this study, we present our experience in a retrospective series of 112 ambulatory tooth extractions under local anesthesia in 23 patients with hemophilia using a coagulation factor replacement therapy in combination with tranexamic acid. The results obtained with this protocol were satisfactory and only one episode of mild postoperative bleeding occurred after seven days in a patient who did not have good treatment compliance.
Key words:Hemophilia, factor replacement therapy, tooth extractions, postoperative complications.
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Affiliation(s)
- Emilio A Ramos
- DDS. Maxillofacial Surgery Department Staff, Dr. César Milstein Hospital, Argentina
| | - Maximiliano Diamante
- DDS. Head of the Maxillofacial Department, Dr. César Milstein Hospital, Argentina
| | - Diego Caruso
- MD, MSc. Head of the Clinical Research Department, Dr. César Milstein Hospital, Argentina
| | - Juan M Muiño
- DDS. Residents instructor, Maxillofacial Surgery Department, Dr. César Milstein Hospital, Argentina
| | - Alejandra Baques
- MD. Hemophilia and Complex Coagulopathies Department Staff, Dr. César Milstein Hospital, Argentina
| | - Ludmila B Antonelli
- DDS. Chief Resident, Maxillofacial Surgery Department, Dr. César Milstein Hospital, Argentina
| | - Josefina Gutierrez
- DDS. Resident, Maxillofacial Surgery Department, Dr. César Milstein Hospital, Argentina
| | - Marcelo O Minigutti
- MD. Hemophilia and Complex Coagulopathies Department Staff, Dr. César Milstein Hospital, Argentina
| | - Gabriela Guerrero
- MD. Hemophilia and Complex Coagulopathies Department Staff, Dr. César Milstein Hospital, Argentina
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HERMANS C, ALTISENT C, BATOROVA A, CHAMBOST H, DE MOERLOOSE P, KARAFOULIDOU A, KLAMROTH R, RICHARDS M, WHITE B, DOLAN G. Replacement therapy for invasive procedures in patients with haemophilia: literature review, European survey and recommendations. Haemophilia 2009; 15:639-58. [DOI: 10.1111/j.1365-2516.2008.01950.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Eigner TL. Use of intraligamentary anesthesia in a patient with severe hemophilia and factor VIII inhibitor. SPECIAL CARE IN DENTISTRY 1990; 10:121-4. [PMID: 11100219 DOI: 10.1111/j.1754-4505.1990.tb00773.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article reviews the therapeutic problems that arise in the dental management of hemophilia patients with inhibitor and suggests an anesthesia technique that may eliminate the need for factor replacement during restorative procedures. Intraligamentary anesthesia was used during restorative procedures that were performed throughout an 8-year period on a patient with factor VIII inhibitor. Multiple restorative procedures were accomplished without the use of replacement factor and with no postoperative bleeding. This technique, in consultation with the patient's physician, may be performed by most general practitioners in their private offices.
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Affiliation(s)
- T L Eigner
- Oregon Health Sciences University, Portland 97201, USA
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Ramström G, Blombäck M, Egberg N, Johnsson H, Ljungberg B, Schulman S. Oral surgery in patients with hereditary bleeding disorders. A survey of treatment in the Stockholm area (1974-1985). Int J Oral Maxillofac Surg 1989; 18:320-2. [PMID: 2533604 DOI: 10.1016/s0901-5027(89)80026-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The results on the oral surgical management of patients with coagulation disorders at the Karolinska Hospital, Stockholm, during the period 1974-1985 have been compiled and compared with those obtained during the period 1965-1973. The present study included 380 tooth extractions performed in 250 treatment sessions in 107 patients. The incidence of postoperative bleeding and duration of hospitalization were reduced during the period of investigation.
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Affiliation(s)
- G Ramström
- Department of Oral and Jaw Diseases, Karolinska Hospital, Stockholm, Sweden
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Stajcić Z, Baklaja R, Elezović I, Rolović Z. Primary wound closure in haemophiliacs undergoing dental extractions. Int J Oral Maxillofac Surg 1989; 18:14-6. [PMID: 2497202 DOI: 10.1016/s0901-5027(89)80007-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
215 teeth were extracted in 62 haemophiliacs following a single infusion of factor VIII supplemented with antifibrinolytics. Tooth sockets were packed with Sorbacel gauze soaked with an antifibrinolytic. 1 group was sutured and the other left open. Primary closure of the extraction wound did not show direct effect on haemostasis. However, the size of the clot showed a statistically significant difference between the primary closure and open wound groups. The authors conclude that primary closure of the extraction wound protects the blood clot, makes the postoperative period more comfortable for patients and may subsequently decrease the risk of postoperative bleeding.
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Affiliation(s)
- Z Stajcić
- Oral Surgery Clinic, Faculty of Stomatology, University of Belgrade, Yugoslavia
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Sindet-Pedersen S, Stenbjerg S. Effect of local antifibrinolytic treatment with tranexamic acid in hemophiliacs undergoing oral surgery. J Oral Maxillofac Surg 1986; 44:703-7. [PMID: 2943883 DOI: 10.1016/0278-2391(86)90039-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The objectives of the present clinical investigation were to examine the effects in hemophiliacs of local antifibrinolytic treatment with tranexamic acid on the incidence of postoperative bleeding after oral surgery and on the amount of replacement therapy needed to control bleeding. The study compared three groups of patients. The patients in group A received high doses of factor concentrate and systemic antifibrinolytic treatment with tranexamic acid. In group B local antifibrinolytic treatment with tranexamic acid was added to the treatment received by group A. Group C received replacement therapy to raise factor levels to approximately 10% of the normal value perioperatively, combined with systemic and local antifibrinolytic treatment (mouth rinse) with tranexamic acid. The study demonstrated that local antifibrinolytic therapy with tranexamic acid as a supplement to the currently used systemic therapy significantly reduces the incidence of postoperative bleeding. The results of the study further suggest that replacement therapy can be reduced during oral surgery in the hemophilic patient provided that local and systemic inhibition of fibrinolysis is instituted.
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Suzuki H, Kaneda T. Tooth extraction in two patients who had a congenital deficiency of factor XIII. J Oral Maxillofac Surg 1985; 43:221-4. [PMID: 3156225 DOI: 10.1016/0278-2391(85)90165-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Two cases of the extraction of deciduous teeth in unrelated patients who had congenital Factor XIII deficiency are reported. The modes of inheritance of the deficiency are discussed, and methods of screening, diagnosis, and treatment are suggested. A combination of a local hemostatic treatment and transfusion of Factor XIII concentrate resulted in the sockets healing without further postoperative bleeding in both cases.
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