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Special care dentistry: part 3. dental management of patients with medical conditions causing acquired bleeding disorders Najla Nizarali Sobia Rafique Dental Update 2024 40:10, 707-709.
Authors
NajlaNizarali
Specialist in Sedation and Special Care Dentistry, Department of Sedation and Special Care Dentistry, Floor 26 Tower Wing, Guy's Hospital, London Bridge, London SE1 9RT, UK
Consultant Special Care Dentistry, Department of Community Special Care Dentistry, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
The second paper in this three part series discussed the dental management of patients with drug-related acquired bleeding disorders. This paper will discuss and outline the dental management of patients with acquired bleeding disorders that can result from medical conditions. Again, these may be associated with vascular defects, platelet defects or coagulation defects. In an age when people are living longer, and medical interventions are continually becoming more advanced, clinicians will need to be aware of systemic disorders and treatments that may cause complications in the dental setting.
Clinical Relevance: Being able to recognize which medical conditions, including their management, may cause bleeding problems at an early stage will lead to good patient management, particularly in planning and delivering treatment involving any invasive dental procedures that can cause bleeding. Whilst most patients can be successfully treated in general dental practice, the clinician may need to make a decision on whether or not to refer a patient to specialist services for all dental treatment, or to share care between primary care and specialist services.
Article
There are many acquired medical conditions in which the patient may be on some of the drugs described in paper 2, therefore leading to increased bleeding tendencies. For example, some patients with heart valve replacement will be taking anticoagulants, or patients that have had organ transplants may be on corticosteroids.
However, there are several acquired medical conditions that can directly affect normal haemostasis. In this paper, acquired conditions in the following groups will be discussed:
The liver plays a major role in haemostasis as:
Alcohol misuse is one of the causes of liver disease leading to cirrhosis, which has been attributed to 3000 deaths per year in England and Wales. It is estimated that up to 10% of the United Kingdom population have problems with their liver, most likely linked to lifestyle factors such as heavy drinking, obesity and diabetes. Average alcohol consumption in this country has risen steadily and it is estimated that 26% of the adult population in this country drink in excess of the recommended limits for sensible drinking. Alcohol misuse is implicated in up to 22,000 deaths per year in England and Wales.2 Post-operative bleeding is a common complication in alcohol-dependent patients as a result of:
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