In oral surgery, patients with inherited bleeding disorders have historically had factor cover where possible. Factor support is expensive, time consuming to administer and places the patient at a potential risk of complications of therapy. A protocol employing rigorous local measures and minimal factor replacement was used to obtain haemostasis following simple and complex oral surgery on 50 consecutive patients with inherited bleeding disorders, referred to the Alfred Health Dental Unit from the Ronald Sawers Haemophilia Centre, Alfred Health, Melbourne. Excellent haemostasis was achieved using standardized local measures of 5% tranexamic acid solution, surgicel and monocryl sutures. Oral surgery may be considered safe to perform in patients with inherited bleeding disorders using minimal factor support and meticulous local haemostatic measures.

Avoidance of dental care and neglect of oral health may occur in patients with inherited bleeding disorders because of concerns about perioperative and postoperative bleeding, but this is likely to result in the need for crisis care, and more complex and high-risk procedures. Most routine dental care in this special needs group can be safely managed in the general dental setting following consultation with the patient's haematologist and adherence to simple protocols. Many of the current protocols for dental treatment of patients with inherited bleeding disorders were devised many years ago and now need revision. There is increasing evidence that the amount of factor cover previously recommended for dental procedures can now be safely reduced or may no longer be required in many cases. There is still a need for close cooperation and discussion between the patient's haematologist and dental surgeon before any invasive treatment is performed. A group of hospital based dentists from centres where patients with inherited bleeding disorders are treated met and, after discussions, a management protocol for dental treatment was formulated.Keywords: Blood coagulation disorders ⁄ complications, dental care, haemophilia, haemostatics ⁄ therapeutic use, von Willebrand disease.Abbreviations and acronyms: HDS = hospital dental service; HTC = haemophilia treatment centre; NSAIDS = Non-steroidal anti-inflammatory drugs.

Myeloid sarcoma, also commonly termed granulocytic sarcoma or chloroma, is a rare condition involving infiltration of immature myeloid cells in an extramedullary site. Myeloid sarcoma is often related to leukaemia; however, the condition can also occur in association with various myeloproliferative disorders. Although myeloid sarcoma can occur in any body part, involvement of the neoplastic condition in the oral cavity is infrequent with only 37 cases reported in the literature. We will describe two cases of oral myeloid sarcoma observed at The Alfred Hospital's Dental Unit and discuss their presenting features, diagnosis and subsequent management.

Background: Patients with inherited bleeding disorders have historically had factor cover for oral surgery. Factor support is expensive, time consuming and places the patient at a potential risk of blood-borne diseases. This case describes the use of a significant reduction in factor support for a severe haemophilia B patient having third molars surgically removed. Methods: Local measures were used after a single preoperative dose of Factor IX to obtain good postoperative haemostasis. Results: Excellent haemostasis was achieved using local measures of 5% tranexamic acid solution, SurgicelÒ and MonocrylÒ sutures after a single preoperative dose of Factor IX. Conclusions: Oral surgery may be performed on patients with inherited bleeding disorders using minimal factors and local haemostatic measures. A study of this patient population has commenced at The Alfred Hospital.

Oral plasmablastic lymphoma is a rare malignancy that is associated with patients with HIV or other immunosuppression. This article describes a case of a patient with severe haemophilia A (<1% factor VIII) who had medically acquired HIV and hepatitis C, a CD4+ count of 192 cells ⁄ lL and a viral load of 33 200 copies ⁄ mL. The patient presented with a two-month history of a firm swelling around a lower molar. The tooth was removed and the surrounding tissue biopsied. The importance of obtaining an early definitive diagnosis and seeking adequate medical treatment is discussed.Keywords: Oral plasmablastic lymphoma, HIV, haemophilia.Abbreviations and acronyms: EBV = Epstein-Barr virus; HAART = highly active anti-retroviral therapy; OPL = oral plasmablastic lymphoma; PFM = porcelain fused to metal.