Physiological basement of patients preparation to tooth extraction at blood diseases
Such patients can have complications as bleedings after operations. That’s why doctor before dental manipulation performance must ask the patient whether he had prolonged bleedings at wounds or operations. If it is necessary the patient must be consulted in hematologist. In separate patients with blood diseases dental operations should be done at in-patient department.
At hemophilia in patient dentist should follow systemic approaches 1st stage:
· anamnesis taking;
· X-ray examination;
· special protective plates making from plastic mass (such plates are putted right before the operation or in the operation day).
The IInd stage – operational one. Local anaesthesia should be done with thin needle application. All manipulations on tooth extraction are sparing with maximal mucosa ruptures. They perform hemostasis with haemostatic sponge application, thrombin, aminocapronic acid and protective plate. They perform replacement therapy by hemopreparations injecting (plasma +necessary coagulation factors).
The IIIrd stage – post-operational. Replacement therapy continuation.
Complications occurring after tooth extraction in patients with blood coagulation disorders
In such patients there can be long-termed massive bleedings from oral mucosa at its traumas and especially after tooth extraction. In patients with haemophilia tooth is more widely spread. It is delt with teeth mineralization disorder on the background of total decalcination due to frequent bleedings. Frequent bleedings lead to clots appearance in cavity and thus to bacterias and inflammation development.
Study aims:
To know: processes sequence during coagulational hemostasis, its phases; salivary glands role in coagulational hemostasis.
To be able to: analyze express-coagulogram.
Pre-auditory self-work materials.
3.1.Basic knowledge, skills, experiences, necessary for study the topic:
| Subject | To know | To be able to |
| Biology and Medical Genetics | Inheritance main ways | Analyze primary coagulopathies inheritance ways |
| Pathophysiology | Blood coagulation reasons, classification, blood analysis changes and developmental mechanisms | Interpretate data received about blood coagulation, coagulation time |
| Pediatry with Neonatology | Coagulative hemostasis peculiarities in children of different age | Say about coagulation in children |
| Internal Diseases | Secondary hemostasis mechanism, its importance in general medicine | Tell about ethiology, pathogenesis, treatment and prevention of secondary hemostasis disorders |
| Surgery | About ethiology, pathogenesis, treatment and prevention of secondary hemostasis disorders in part thromboses and thrombophilias | To prevent and to liquidate complications after teeth extraction in patients with coagulation hemostasis disorders |
| Dentistry | Oral cavity organs role in secondary hemostasis, complications after teeth extraction in patients with coagulation disorders | To prevent and to liquidate complications after teeth extraction in patients with secondary hemostasis disorders |
Topic content
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Blood coagulation is an enzyme process where both the plasmic and the cell factors participate. Most of the hemocoagulation plasma factors are the proenzymes and their activation occurs due to the limited proteolysis and is accompanied by the peptide inhibitors cleavage. They are designated the Roman figures. There are 13 such factors in plasma.
The platelets play an important role in a blood coagulation process. They contain a lot of (more than 30) different substances which deal with the hemostasis process. Some of them (according to the various literature scientific sources from 5 to 15) are called the platelet (thrombocyte) coagulation factors are designated by the ArabicCiphras.
In the erythrocytes one can find a number of substances like the platelet ones. They are known as the erythrocyte blood coagulation factors. They have no figure designation. The leukocytes have the coagulation factors called leukocyte factors. For example, monocytes and macrophages upon antigen stimulating synthesize the protein thromboplastin part namely apoprotein III (tissue factor).
Tissue factors the main component of which is thromboplastin play a significant role in a blood coagulation. Thromboplastin or tissue factor consists of the protein part apoprotein III and the phospholipid complex and it is often considered to be a cell membrane fragment. Upon the tissue destruction or endothelium stimulation by means of proinflammatory cytokines or endotoxin the tissue factor can be released in a blood circulation. In various blood circulation regions in the vessels its content differs (e.g. in veins and arteries, lower or upper extremities, on the right or on the left in ones of the same name).
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