Use of intraligamentary anesthesia in a patient with severe hemophilia and factor VIII inhibitor

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.

Electrocardiographic examination of dental patients with systemic lupus erythematosus

Cardiac complications and abnormalities associated with systemic lupus erythematosus (SLE) have been well described. The most well-recognized cardiac myopathies in SLE are pericarditis and valvular problems such as verrucous endocarditis. Electrocardiogram (EKG) abnormalities and arrhythmias have also occurred and such individuals may have persistent tachycardia. To determine the prevalence of dental patients with SLE who have these EKG changes, a pilot study was designed in which a group of 13 subjects with SLE underwent EKG monitoring in the clinic. Most of these were patients referred to the oral medicine clinic. A randomly selected group of age-gender matched controls were monitored in an identical manner. All subjects first completed a cardiac screening questionnaire, were comfortably seated, and then monitored. The results indicated that the overall prevalence of EKG abnormalities among the subjects with SLE was 61.5% (n = 8). The most common arrhythmia was supraventricular extrasystoles. These were compared with a control group with a prevalence of 23% (n = 3). Of the 76.9% of the subjects with SLE who reported a positive history of cardiac abnormalities, 80% demonstrated EKG abnormalities as compared with 50% of the control group. Of the subjects with SLE who did not report a previous history, none demonstrated EKG abnormalities as was the same for the control group. These results indicate a high prevalence of EKG abnormalities in dental patients with SLE, especially those with a positive cardiac history.