Wednesday, 17 April 2013

Haemophilia and Dental Care

Hemophilia is a genetic, life threatening bleeding disorder. In persons with hemophilia (PwH) blood does not clot normally due to deficiency or absence of clotting proteins called Factors. PwH tend to bleed internally and externally even with a minor injury.


  1. Hemophilia A:Hemophilia A is a deficiency of factor VIII
  2. Hemophilia B:Hemophilia B (Christmas disease) is a deficiency of factor IX.

Types of Hemophilia A and B

Types of Hemophilia A and B

Degree of Deficiency/Plasma activity

Risk of a Bleed After Trauma or Surgery


5% to 30% |6 and 40 IU/dL

Delayed onset of a bleed with trauma or surgery or dental extractions


1% to 5%| 2 and 5 


Excessive bleeding with surgery


 <1 IU/dL

Excessive bleeding with trauma or surgery

Dental treatment 

It is essential to prevent accidental damage to the oral mucosa when carrying out any procedure in the mouth. Injury can be avoided by: 

  • Careful use of saliva ejectors; 
  • Careful removal of impressions; 
  • Care in the placement of X-ray films, 
  • Protection of soft tissues during restorative treatment by using a rubber dam or applying yellow soft paraffin.

Periodontal treatment

Periodontal health is of critical importance for the hemophiliac for two principle reasons:-
  1. Hyperemic gingival contribute to spontaneous and induced gingival bleeding.
  2. Periodontitis is a leading cause of tooth morbidity, necessitating extraction.
Periodontal surgery requires LA and Factor VIII replacement to a level of between 50 and 75%. As expected postoperative factor level maintenance is case-dependent. In all but severe hemophiliacs, scaling can be carried out with topical anesthesia. . The treatment may need to be carried out over several visits to prevent excessive blood loss. In addition, chlorhexidine gluconate mouthwash can be used to control periodontal problems. Antibiotics may be required to help reduce the initial inflammation. Blood loss of all kinds can be controlled locally with direct pressure or periodontal dressings with or without topical antifibrinolytic agents. 

Restorative procedures 

Restorative treatment can be undertaken routinely providing care is taken to protect the mucosa. There is a risk of bleeding with the use of matrix bands or wooden wedges. This can be controlled by local means or the application of topical agents.


In all but severe hemophiliacs endodontic treatment (taking into consideration the question of LA discussed previously) can be usually carried out under antifibrinolytic cover (usually tranexamic acid). Avoiding instrumentation through the periapex is of prime importance in endodontic therapy. The use of electronic endometric instruments will reduce the number of intraoperative radiographs. Rubber dam usage is mandatory as expected. Intracanal injection of LA solution containing adrenaline or topical application (using paper points) of adrenaline 1:1000 may be useful to minimize bleeding.

Orthodontic treatment 

Fixed and removable orthodontic appliances may be used along with regular preventive advice and hygiene therapy. Special care should be taken when treating patients with a severe bleeding disorder to ensure that the gingiva is not damaged when fitting the appliance.

Removable prosthodontics 

Patients with bleeding disorders can be given dentures as long as they are comfortable. If a partial denture is provided it is important that the periodontal health of the remaining teeth is maintained.

Anesthesia and pain management

Dental pain can usually be controlled with a minor analgesic such as paracetamol .Aspirin should not be used due to its inhibitory affect on platelet aggregation. The use of any non-steroidal antiinflammatory drug (NSAID) must be discussed beforehand with the patient's hematologist because of their effect on platelet aggregation. 
There are no restrictions regarding the type of local anesthetic agent used although those with vasoconstrictors may provide additional local hemostasis. It is important to advise patients and parents of children about the risks of local oral trauma before the anesthetic wears off. 
Infiltration injections pose no risk to patients with hemophilia. However, they should be administered slowly. Inferior Dental Blocks (ID Blocks) may potentially cause a muscle bleed which might compromise the airway. These should be avoided where possible. Alternative techniques such as buccal infiltrations with articaine or intra-ligamentory routes should be considered for anaesthesia of molar teeth. If an ID Block is unavoidable, patients with less than 30% factor levels will require factor replacement prior to its administration.


Extractions and surgery, gingival surgery/deep root planing and implant placement all pose a bleeding risk, even in patients with mild hemophilia so it is essential that these procedures are carried out with the necessary pre-operative special measures such as factor replacement, DDAVP or Cyclokapron tablets. If such procedures are required, please refer your patient with a dental treatment plan and suitable radiograph to your hemophilia treatment centre, and the on-site dental team will organise and/or carry out the treatment if required.

Dental emergencies 

Dental emergencies can occur at any time; however, it is important to remember that no treatment should be carried out without prior planning as this could result in additional problems. 


  1. Useful information. Lucky me I discovered your web site
    unintentionally, and I am shocked why this twist of fate didn't took place in advance! I bookmarked it.

    Review my web site;

  2. Ӏ truly loνe your blog.. Excеllent cоloгs & thеme.
    Did you develοp thіs amazing site уоurself?
    Ρleasе reply back as I'm trying to create my own site and would love to learn where you got this from or exactly what the theme is called. Thank you!

    Feel free to visit my website - crear facebook gratis

  3. Generally I do not read post on blogs, however I would like to say
    that this write-up very pressured me to take a look at and do
    so! Your writing style has been surprised me. Thanks, very nice article.

    My web page ...

  4. I like the valuable info you provide in your articles. I'll bookmark your blog and check again here regularly. I'm quite sure I will learn plenty of
    new stuff right here! Good luck for the next!

    Also visit my webpage -

  5. You can keep your smile bright by following several teeth whitening tips such as using a straw when drinking dark beverages or by brushing after every snack or meal.

  6. When your dental problem got worst, you really need the further treatment for it just like surgery.

  7. I just wanted to add a comment here to mention thanks for you very nice ideas. You provided readers with very useful information. Can you please tell me how much Periodontal treatment will cost?

  8. That is great information. I should be able to work with this. I still think I need to see go to one of the dentists in Greeley, CO but this is a start.

  9. Good post! Thanks for sharing this information I appreciate it. God bless!

    pediatric dentist wakefield ma

  10. Very informative blog! Each and every aspect of the dental treatment and care is very nice mentioned here. Immensely helpful article that can spread dental awareness.

  11. Amazing Content!! Really I was confuse on the same but now satisfied, I was visit one more website like you laser teeth whitening.

  12. I really appreciated with your content and completely agree with you, here also I was visit a company website which is like you Teeth whitening.

  13. Its very useful to people and i really tell in close to my heart and keep more posting to this blog thank you for posting this blog


  14. This blog is awesome keep more posting

  15. Great. I learn a lot with your blog. Where is your dental clinic?

  16. When I am suffering from teeth problem then I have followed the teeth whitening tips and now my teeth are clean and strong.

  17. I truly love your blog. I like the valuable info you provide in your articles. thanks a lot.
    on page seo

  18. I visite the blog site. I like the valuable info in this site.

  19. Excelent post. I want to share this blog post

  20. Thank you for the break down of the common causes of bad breath, this sure made me more aware and conscious about my dental health.

    click here

  21. There are lots of Blogs and Articles on oral health, but when I read this one, really inspired by your writing skills and thoughts. I found this blog very informative and Interesting. Keep it up and thanks for sharing

  22. Valuable information. Lucky me I discovered your web site unintentionally, and I'm surprised why this accident did not came about in advance!
    I bookmarked it.

    My webpage: money robot

  23. If some one wants expert view on the topic of blogging and site-building then i advise him/her to pay a quick visit this web
    site, Keep up the pleasant job.

    Also visit my site: dental office (

  24. I love this blog its awesome thank you for posting this blog keep more posting its very useful to people and thank you once again.

  25. Thanks for sharing helpful dental care tips here. But I want to know, how we can find out best dentist in Torrance for all type of dental treatment?

  26. Mimosa, I'd never heard of Haemophilia before; are most dentists aware of this disorder? It seems like it's pretty important to be aware of this to avoid any bleed-outs. Modern dentistry equipment appears to be getting better and better. I've heard that many people rarely experience extreme discomfort and bleeding. Either case, it's important to be aware of this disorder so no accidents happen.

    1. Yes..Dentists are aware of this disease...And it is important to know...Because patients with haemophilia have bleeding disorder & blood does not clot...Dentists have to face sever consequence... as this can be life threatening...

  27. Having haemophilia A this means that his body, his immune system, fights off the medicine – the infused factor VIII. The alternative clotting factors that we used to control bleeding were much less effective. His medical condition was heart broken. Despite our visit to several doctors his health wasn't getting better. He was subjected to different medications, by many doctors for treatment without the assurance of having a permanent cure. Having a son with hemophilia and then, the added challenge of an inhibitor, is not always easy. Suspicion that something wasn’t right began when he was 6 months old due to the heavy amount of bruising which started showing up all over his legs. As a parent, I would love to fix things and make everything better. Fortunately, there have been other positive alternative (Herbal Medicine) though few people doesn't know the challenges of living with hemophilia. If your child is having same problem, do not expose him/her to more danger, use a herbal remedy that is safe and effective. Contact him directly for more info with his email address:


Related Posts Plugin for WordPress, Blogger...