Preliminary steps to computerization.

Selecting a computer system for a dental office is a complicated process and the author recommends that this be preceded by a careful practice analysis. Examples of the practicality of computerization are typified in several examples and many common pre-purchase suggestions and guidelines are provided. The need for staff involvement and adequate product review prior to purchase is discussed.

Computer hardware selection.

After a suitable practice management software package has been selected, computer hardware will need to be purchased. Selection of the system hardware is dependent upon the requirements of the software to be used. The major hardware options as they pertain to practical use are addressed. Measures to improve reliability and service considerations are also discussed.

Computer software selection.

For many dental offices, good practice management software can offer significant benefits. A knowledge of available features, practice needs, and proper vendor selection are vital to initial and extended product satisfaction. This article discusses many available software features, their practicality, and proposes vendor demonstration and support obligations. Current legal issues, hidden costs, and data backup are presented as they pertain to the software selection process.

Inherited factor X deficiency: presentation of a case with etiologic and treatment considerations.

The first documented case of inherited factor X deficiency in the dental literature is presented. Its ascertainment as a result of postoperative surgical complications illustrates the clinician's need to be familiar with the hereditary bleeding diatheses, as treatment is dependent on the underlying etiology of the specific disorder. In the present case treatment included administration of the antifibrinolytic agent epsilon-aminocaproic acid (EACA) and fresh frozen plasma. On the basis of our findings, a minimal therapeutic level of circulating factor X is estimated to be 15 percent of the normal level. Genetic heterogeneity within the factor X deficiency phenotype is discussed and, on the basis of laboratory findings, a CRM-positive autosomal recessive structural or regulator gene defect is proposed as the etiologic factor in the current case. Forty-nine cases in the literature are reviewed to delineate the pattern of bleeding in hereditary factor X deficiency.

DDAVP: review of indications for its use in the treatment of factor VIII deficiency and report of a case.

Classic hemophilia or factor VIII deficiency is a recessive, sex-linked bleeding diathesis. The primary clinical problem is hemorrhage, which can be severe and often life threatening, even in the presence of only minor trauma. In the past this inadequate hemostasis has been treated with transfusions of cryoprecipitate, fresh frozen plasma, or commercially prepared factor VIII concentrate. Unfortunately, such treatment carries with it a number of risks, including the development of hepatitis B or hemolytic anemia and the formation of anti-factor VIII antibodies. Because of hemorrhage severity and the risks of conventional treatment, elective surgery in general and oral surgery in particular have often been neglected in patients with hemophilia. This article reviews a drug, 1-desamino-8-d-arginine (DDAVP), heretofore not discussed in the dental literature, and reports on its use in conjunction with epsilon-aminocaproic acid (EACA), a synthetic antifibrinolytic agent, in the surgical dental treatment of a patient with hemophilia A. The results suggest that certain dental surgical procedures can be performed in the presence of subclinical and mild hemophilia without conventional factor VIII replacement therapy with its associated costs and risks.