This article reviews the therapeutic problems that arise in the dental management of hemophilia patients with inhibitor and suggests an anesthesia technique that may eliminate the need for factor replacement during restorative procedures. Intraligamentary anesthesia was used during restorative procedures that were performed throughout an 8-year period on a patient with factor VIII inhibitor. Multiple restorative procedures were accomplished without the use of replacement factor and with no postoperative bleeding. This technique, in consultation with the patient's physician, may be performed by most general practitioners in their private offices.
The incidence of oral cancer has increased in the past ten years. Early diagnosis and treatment are essential to long-term survival; however, patients at highest risk visit the dentist infrequently. The reddish, velvety or erythroplakial lesion at the base of the tongue or floor of the mouth is highly suspicious in any patient and requires further evaluation. High-risk patients with less suspicious appearing lesions must be reevaluated on close recall. Prognosis improves vastly when the lesion is detected and treated early. One study demonstrated a 64% five-year survival rate for patients with oral cancer that was diagnosed before regional lymph node involvement versus a 15% five-year survival for patients whose lesions were diagnosed after regional lymph node involvement. By including an oral cancer examination in routine physical examination of patients, the physician and public health nurse can increase the likelihood of early detection of oral cancer.
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