-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