Consensus statement by hospital based dentists providing dental treatment for patients with inherited bleeding disorders*

Abstract

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.

Dental implants in patients affected by systemic diseases

“…74,75 In patients with inherited bleeding disorders, any elective surgery should be carefully planned and discussed with the haemophilia centre. The following guidelines have been proposed: 76,77 • Augmentation of the coagulation factor before surgery (and before nerve block). It is recommended that for invasive procedures the coagulation factor reaches a minimum level of 50% • Peri-and post-operative use of antifibrinolytic agents (oral tranexamic acid and/or 5% tranexamic mouthwash).…”

Nacionalna priporočila za obravnavo bolnikov s hemofilijo

“…Vbrizganje mora pri odraslih potekati počasi skozi čim tanjšo iglo, izvajati pa jo sme izkušeni strokovnjak. Za preprečitev bolečine se priporoča pred injekcijo anestetika v ligament ali papilo še bukalna infiltracijska anestezija (120,(123)(124)(125). Otroci na profilaktičnem zdravljenju naj prejmejo lokalno anestezijo takoj po rednem vbrizganju koagulacijskega faktorja, zato se obisk pri zobozdravniku uskladi z urnikom profilaktičnega nadomestnega zdravljenja (73).…”

“…Lahko se uporabljajo vse vrste lokalnih anestetikov. Rutinsko se uporablja 2-odstotni lidokain v adrenalinu v razmerju 1:80.000 (123). Z articainom v adrenalinu v razmerju 1:100.000 se doseže boljše penetriranje v kost (126,127).…”

“…Pri odraslih je pri izdrtju zob in drugih invazivnih posegih poleg nadomestnega zdravljenja za dvig manjkajočega faktorja uporaba resorbilnih ali neresorbilnih šivov učinkovit dodatni ukrep (123). Pri otrocih jih večino-ma uporabljamo, kadar so posegi narejeni v splošni anesteziji (73).…”

Efficacy of tranexamic acid mouthwash as an alternative for factor replacement in gingival bleeding during dental scaling in cases of hemophilia: A randomized clinical trial

“…[4567] Though widely discussed, these hemophiliacs often face problems in acquiring the primary care. The options available in the existing literature to control bleeding during primary dental care are, factor replacement therapy (FRT), release of endogenous factor stores and clot stabilization by antifibrinolytic agents,[89101112] with FRT being the main mode of treatment. The development of recombinant FRT has minimized the risk of blood borne infections, but, the major disadvantage reported is the formation of antibodies or inhibitors;[12] even cost of therapy is high ranging from  Indian Rupees (INR or `) 6000 to 20,000, depending on the severity of the bleeding, purity, type and amount of factor used.…”