Lecture 2 practical
Dr. Lana Shabur TalabaniM.Sc. Oral Medicine
• Thrombocytopenia
• For periodontal or maxillofacial surgery platelet count should be above 75.000/mm3
• For major surgeries with general anesthesia platelet count should be• above 100.000/mm3
• Spontaneous bleeding occurs when the platelet count is below 20.000/mm3
• Elements of Hemostasis
• Adequate blood vessel response.• Adequate platelet count.
• Adequate platelet function: Bleeding time.
• Adequate level of Von Willebrandʼs factor.
• Adequate levels of clotting factors : PT/INR, PTT.
• Clotting Factor Tests
• PT (Prothrombin Time)• Tests extrinsic and common pathways.
• Normal (11-15 sec)
• Coumarin therapy PT at 1.5 to 2.5 time
• International normalized
• ratio INR=1
• Surgery can be done if INR < 3
• Partial thromboplastin time (PTT)
• Tests intrinsic pathway.
• Normal (25-35sec).
• Affected by heparin anticoagulant
• Case 1
• A 59 years old man presents to the dental office for extraction of one of his lower teeth. History reveals that he had 2 venous thromebolic events and is on warfarin therapy (oral anticoagulant):
• Which of the following investigations should be performed to evaluate the risk of bleeding?
• Blood glucose level
• ESR
• Complete blood count
• Prothrombin time
• Case 2
• A 18-year old female complains about gingival bleeding and epistaxis in addition to the above lesions.• 1) What are the lab investigations that should be performed?
• A 26-year old man attend the dental office for extraction of one of his teeth. History revealed spontaneous gingival bleeding .
• Investigation shows: Hb 13.5 g/dl
• Platelets 12.000
• White blood cells 6.000/mm3 PT (13 sec)
• PTT (26 sec)
• What is the cause of bleeding? Explain.
• A 28 year old lady was diagnosed with acute leukemia. She required extraction of her lower third molar. Her platelet count was found to be 11.000/mm₃
• What is the best action? Why?
• A 37-years old female who has a prosthetic valve came to the dental office complaining of left submandibular swelling. A history of dental pain in the lower left quadrant was reported. On examination a tender left unilateral swelling, limited mouth opening and partially impacted lower left wisdom were observed. The dentist decided that this wisdom is indicated for surgical extraction.
• Mention the needed laboratory tests and its normal values?
• What is the best treatment approach based on the result of the laboratory tests?
• Case 2• A 55-diabetic male complaining of
• burning sensation in his tongue. On examination a diagnosis of pseudomembranous candidiasis was• confirmed . His last random blood glucose level was 350mg/dl .
