Name : YARA DYAB

ID: 21311263

Dear students kindly answer the following question and submit it

before the due date :
You can see the Grading of your assignment after the due date finish

A patient came to you complaining of pain on his lower wisdom

teeth which was carious and needed surgical extraction , when he
opened his mouth you saw an ecchymosis on the palatal mucosa as
seen in the picture and small petechiae in his arm as seen on the
other picture ,,
Write down how you will manage this patient ??

The presence of ecchymosis and petechiae must attract attention

that something abnormal and we have to take history in details
from the patient .

1. History
  Ask the patient if he has any bleeding problem or if relative
have , Ask him if any bleeding problem occurred after
surgery , History of medications that may cause bleeding
problem ?

2. Extraoral and intraoral examination

Is there any sign of bleeding problem other than
petechiae , Is there any hyperplastic gingival tissues ?
What about jaundice , pallor ?

3. Laboratory tests
Bleeding time ( BT) : detect disorders of platelet function or
thrombocytopenia

The partial thromboplastin time (PTT) : check the intrinsic

and common pathway .

Platelet count : check if there is thrombocytopenia

Prothrombin time (PT) : check the extrinsic and common

pathway

Thrombin time: check the common pathway

if we have prolonged bleeding time , we have to see the

platelet count may there is a platelet dysfunction

if there is prolonged aPTT , normal PT and normal

platelet count , there is an intrinsic pathway disorders
 if there is prolonged PT , normal aPTT, there is an extrinsic
pathway disorders.

BUT if we have prolonged PT and aPTT , there is a common

pathway disorders .

After refer the patient to hematologist and diagnosed also

treated with suitable treatment that depend on his specific
illness .

Differential diagnosis

1.abnormal platelets or thrombocytopenia

2. liver disease

 If the patient diagnosis is thrombocytopenia :

If platelet count above 50000 per microliter we can go to extract

the lower wisdom , but if less , patient need platelet replacement .

 If the patient diagnosis is liver disease :

If both PT and the platelet count are normal , surgical extraction

can be performed but if they abnormal the dentist should consult
with the patient physician regarding stabilization of the patients
bleeding status before surgery )

 If the patient take antiplatelet drug such :

Aspirin ( no problem , usually dose not lead to significant
bleeding problem )
 Warfarin ( if INR is 3.5 or less we can go to extract )

Heparin ( most patient are hospitalized and will be prescribed

warfarin once discharged )

And finally before extraction ,

1. we have to determine the difficulty of surgery on CBCT
2. the procedure should be done with as little trauma
3. If the patient take warfarin we should avoid the use of steroids
, acetaminophen or aspirin as a postoperative control pain .
also if excessive postoperative bleeding occurs we can use
Gelfoam , Primary closure , Tranexamic acid or EACA

Also we should follow up the patient .