-HA

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Dental problems in Hemophilia
-HA -HB -Factor XI deficiency -Factor II
deficiency -Factor V deficiency -Factor XIII
deficiency -Factor VII deficiency
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Precoagolant classification
-Severe Deficiency (Less than 1) -Moderate
Deficiency (less than 1) -Moderate Deficiency
(1-5) -Mild Deficiency ( 5)
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Severe deficiency Hemophilia
-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
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• Hemophilia
• Infrequently bleeding
• Only surgery or Trauma

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Medical Treatment of Hemophilia

• Purified concentration factor
• Factor through recombinant technology
• Whole blood , plasma , cryoprecipitate
• Half life factor VIII , IX

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• (Continue)
• Factor VIII concentrate
• Routine bleeding (40)
• Mild VIII Deficiency DDAVP
• DDAVP Rise of factor VIII Activity/VWF
• Tachyphylaxis
• Water Retention
• Hyponautremia
• Seizures

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Hemophilia B Treatment

• Factor IX deficiency
• Purified coagulation factor IX concentrate
• Pure production class protrombine complex
• PCC factor IX
• Repeated PCC Infusion ? DIC
• Level factor (40)

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• Vonwillbrand disease
• Subtyping VWF
• DDAVP (VWF)
• Other modalities

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Complications factor Infusion

• 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

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• Risks to dental staff
• Acquiring hepatitis B,C
• Acquiring HIV

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• Development of a treatment plan in the hemophilia
• Use of anti fibrinolytics ,Dosage
• Side effect

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• Pain control in Hemophilia (Continue)
• Analgesia
• Local Anesthesia
• PDL Injection
• Infiltration
• Block Anesthesia

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Dental Healthcare protocol in hemophilia

• Prevention of Dental Disease
• Periodontal therapy
• Restorative procedures
• Pulp therapy
• Oral surgery
• Surgical complications
• Antibiotic prophylaxis
• Orthodontic treatment

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The end Dr . Jabbarifar 2007
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Oral manifestations HIV Infection

• Fungal Infection
• Viral Infection
• Bacterial Infection
• Neoplasm's
• Idiopathic lesions
• HIV-gingivitis , HIV Periodontitis .

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The end Dr . Jabbarifar 2007