Franchini M, Rossetti G, Tagliaferri A, Pattacini C, Pozzoli D, Lorenz C Dental procedures in adult patients with hereditary bleeding disorders: 10 years experience in 3 Italian Haemophilia Centres. Haemophilia. 2005; 11:504-509
Archer WH, Zubrow HJ. Fatal haemorrhage following regional anaesthesia for operative dentistry in a haemophiliac. Oral Surg Oral Med Oral Pathol. 1954; 7:464-470
Brewer A, Correa ME. Guidelines for dental treatment of patients with inherited bleeding disorders. World Fed Haem Monogr. 2006; (40)
Chohayeb A. Endodontic therapy in the haemophiliac patient. N Y State Dent J. 1981; 47:326-327
Fiske J, Pitt Ford HE, Savidge GF, Smith MO. The expressed dental needs of patients attending a Haemophilia Reference Centre. J Disabil Oral Hlth. 2000; 20
Hoffmann M, Munroe DM. Coagulation 2006: a modern view of haemostasis. Haematol Oncol Clin N Am. 2007; 21:(1)1-11
Kumar JN, Kumar RA, Varadarajan R, Sharma N. Specialty dentistry for the haemophiliac: is there a protocol in place?. Ind J Dent Res. 2007; 18:(2)48-54
Kainulainen K, Karttunen L, Puhakka L, Sakai L, Peltonen L. Mutations in the fibrillin gene responsible for dominant ectopia lentis and neonatal Marfan syndrome. Nat Genet. 1994; 6:(1)64-69
Guttmacher AE, Marchuk DA, White RI Hereditary hemorrhagic telangiectasia. New Engl J Med. 1995; 333:(14)918-924
Beighton P, De Paepe A, Steinmann B, Tsipouras P, Wenstrup RJ. Ehlers-Danlos syndromes: revised nosology, Villefranche, 1997. Am J Med Genet. 1998; 77:(1)31-37
Seligsohn U. Glanzmann thrombasthaenia: a model disease which paved the way to powerful therapeutic agents. Pathophysiol Haemost Thromb. 2002; 38:(5–6)216-217
Pham A, Wang J. Bernard-Soulier syndrome: an inherited platelet disorder. Arch Pathol Lab Med. 2007; 131:(12)1834-1836
Gill JC, Endres-Brooks J, Bauer PJ, Marks WJ, Montgomery RR. The effect of AB blood group on the diagnosis of von Willebrand's disease. Blood. 1987; 69:1691-1695
Laffan M, Brown SA, Collins PW. The diagnosis of von Willebrand's disease. New Engl J Med. 2004; 351:(7)683-694
Murphy SL, Katherine A. Gene therapy for Haemophilia. Br J Haematol. 2008; 140:(5)479-487
Key NS. Inhibitors in congenital coagulation disorders. Br J Haematol. 2004; 127:379-391
White GC, Kempton CL, Grimsley B, Nielson B, Roberts HR. Cellular immune responses in haemophilia: why do inhibitors develop in some, but not all, haemophiliacs. J Thromb Haemost. 2005; 3:1767-1781
Charles R, Hay M, Brown S, Collins PW, Keeling DM, Leisner R. The diagnosis and management of factor VIII and IX inhibitors: a guideline from the United Kingdom Haemophilia Centre Doctors Organisation. Br J Haematol. 2006; 133:(6)591-605
Signs of variant Creutzfeldt-Jacob disease in a patient with Haemophilia: FVIII concentrates most likely cause. Treatment Safety Publication. 2009;
Webster WP, Roberts HR, Penick GD. Dental care of patients with hereditary disorders of blood coagulation. In: Rantoff OD (ed). New York: Harper and Row; 1968
Vianll C, Stassen LF. The dental patient with a congenital bleeding disorder. J Irish Dent Assoc. 2008; 54:24-28
Evans RE, Leake D. Bleeding in a haemophiliac after inferior alveolar nerve block. J Am Dent Assoc. 1964; 69:352-355
Heiland M, Weber M, Schemelzle R. Life threatening bleeding after dental extraction in a haemophilia A patient with inhibitors to Factor VIII: a case report. J Oral Maxillofac Surg. 2003; 61:1350-1353
Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block. Int Endodont J. 2009; 42:(3)238-246
Robertson D, Nusstein J, Reader A, Beck M, Mcartney M. The anaesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth. J Am Dent Assoc. 2003; 138:(8)1104-1112
Katz JO, Terezhalmy GT. Dental management of the patient with haemophilia. Oral Surg Oral Med Oral Pathol. 1988; 66:139-144
Rafique S, Fiske J, Banerjee A. Clinical trial of an air-abrasion/chemomechanical operative procedure for the restorative treatment of dental patients. Caries Res. 2003; 37:360-364
Medline Plus Medical Encyclopaedia: Partial thromboplastin time (PTT) 2009-01-01.: Naveen Kumar;
Borea G, Montebugnoli L, Capuzzi P, Magelli C. Tranexamic acid as a mouthwash in anticoagulant-treated patients undergoing oral surgery. An alternative method to discontinuing anticoagulant therapy. Oral Surg Oral Med Oral Pathol. 1993; 75:29-31
Lee APH, Boyle CA, Savidge GF, Fiske J. Effectiveness in controlling haemorrhage after dental scaling in people with Haemophilia by using tranexamic acid. Br Dent J. 2005; 198:33-38
Special care dentistry: part 1. dental management of patients with inherited bleeding disorders Sobia Rafique Janice Fiske Guy Palmer Blanaid Daly Dental Update 2024 40:8, 707-709.
Authors
SobiaRafique
BDS, MFDS, MSc, SCD, MSCD
Consultant Special Care Dentistry, Department of Community Special Care Dentistry, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
King's College London Dental Institute, Associate Specialist, Department of Community Special Care Dentistry, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
The most common cause of excessive bleeding is idiopathic, but bleeding can also be caused by inherited or acquired conditions associated with vascular defects, platelet defects or coagulation disorders. This paper will cover inherited bleeding disorders. Every clinician will encounter a patient who complains of prolonged bleeding following certain procedures; most commonly dental extractions. In the majority of cases the cause is often a local one and can be managed using simple local measures. However, prolonged post-operative bleeding following dental treatment might be one of the first signs of a bleeding disorder in an undiagnosed patient, necessitating referral for further investigations. Some patients may present with an already confirmed diagnosis of a bleeding disorder, requiring appropriate treatment planning and dental management in an appropriate setting with haematological advice. This paper will provide guidance on how to achieve this.
Clinical Relevance: To update clinicians on the dental management of patients with inherited bleeding disorders and how to decide the most appropriate setting for the provision of dental care.
Article
Occasionally, a prolonged case of bleeding in the dental setting may be the first indication that a patient may have an undiagnosed bleeding disorder which requires further investigation. There are also certain inherited connective tissue disorders which predispose to bleeding problems and the clinician will need to be aware of them before commencing certain procedures. Patients who already know that they have a bleeding disorder are able to alert the clinician during the medical history process so that any invasive treatment can be appropriately planned and managed to avoid any complications. Routine dental procedures often cause oral soft tissue trauma, causing local haemorrhage, but in an individual with an inherited bleeding disorder this may be more problematic; for example, fatal haemorrhage has been reported following regional analgesia for dental treatment in haemophiliac patients.1,2 Therefore, some patients may require prophylactic measures pre-operatively, special precautions peri-operatively and careful management post-operatively.3 Patients with hereditary bleeding disorders are usually registered with a Haemophilia Reference Centre. For patients with a mild to moderate bleeding disorder, a shared care approach might be appropriate, alternating care between specialist hospital care and primary dental care (including specialists in the salaried dental services), depending on the procedure and the nature and severity of the bleeding disorder. Often, a hospital setting is the most appropriate setting for patients with a severe bleeding condition and associated complications, such as HIV, Hepatitis C or inhibitors, who require invasive dental treatment. There is research evidence that has suggested that known haemophiliacs delay and avoid dental care for fear of bleeding from dental procedures so that they require more complex treatment and management by the time that they present.4 Fiske et al5 reported many barriers to accessing dental care, including travelling to specialist centres, waiting times, increased treatment needs and cost. However, there is a dearth of evidence-based guidelines and protocols in managing patients with inherited bleeding disorders3 and this paper aims to provide some further guidance on this subject.
Register now to continue reading
Thank you for visiting Dental Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:
