Inherited bleeding disorders in oral procedures. Assessment of prophylactic and therapeutic protocols: a scoping review

Dental management of people with congenital hemophilia: An integrative review of case reports and case series from a global scenario

OBJECTIVE

To analyze the various dental management strategies adopted to manage patients with hemophilia in a dental clinical setup.

METHODS

An electronic database search was carried out using MEDLINE by PubMed, Scopus, Google Scholar, Web of Science, and EMBASE databases from January 2000 to August 2023 for case reports and case series published in English language. Case reports addressing the dental treatments for people with hemophilia A/hemophilia B were included. Cases of acquired hemophilia and cases of hemophilia who are inhibitor positive were excluded.

RESULTS

There was a total of 286 articles that were identified of which 24 reports were included for the review. This included 20 case reports and four case series which addressed various dental treatment procedures performed on people with mild/moderate/severe hemophilia A or hemophilia B. A total of 28 patients were presented with a mean age of 20.4 years. The pre-treatment factor ranged from 200 to 2500 IU and the post-treatment factor range was 1000-3000 IU.

CONCLUSIONS

There was a wide range of variation in the utilization of prophylactic factors for dental treatment procedures among people with hemophilia. This variation highlights the need for larger prospective clinical studies that address the rationale for using clotting factor concentrate and its impact on dental treatment outcomes for individuals with mild, moderate, or severe hemophilia.

Dental Considerations in Children with Inherited Bleeding Disorders and Inhibitors: A Systematic Review

Background/Objectives: This systematic review evaluates the effectiveness of various hematological treatment protocols and local hemostatic measures in preventing oral bleeding and other complications during and after dental treatments in children with inherited bleeding disorders and inhibitors. Methods: This study was registered in the PROSPERO database. The comprehensive search strategy for this systematic review was conducted across five databases, namely, PubMed, Google Scholar, Web of Science, Scopus, and Cochrane Library. The search was aimed at identifying relevant literature published from January 2000 up to February 2024. Eligible studies included those with various designs, such as randomized controlled trials (RCTs), observational studies, cohort studies, case-control studies, and cross-sectional studies. Data extraction was carried out systematically, and relevant information on study characteristics, interventions, treatment protocols, local measures, complications, and outcomes was collected. Results: The systematic review included a total of five studies, encompassing participants ranging from ages of 2 to 18 years. These studies varied in their scope, with some focusing on hemophilia A with inhibitors while others addressed broader inherited bleeding disorders. The interventions examined included various prophylactic and treatment measures such as Emicizumab, recombinant factor VIIa, and local hemostatic measures. The study outcomes primarily assessed the efficacy of these interventions in preventing postoperative bleeding and improving quality of life. Emicizumab has significantly shifted the treatment paradigm for children with inherited bleeding disorders and inhibitors. This prophylactic treatment has been associated with a marked reduction in the frequency of bleeding episodes, fewer hospital admissions for bleeding management, and enhanced participation in daily activities. Conclusions: This review highlights gaps in the management of dental care in children with inherited bleeding disorders and inhibitors. It underscores the need for standardized protocols that integrate new prophylactic treatments such as Emicizumab. Our findings suggest that adopting updated protocols can significantly reduce bleeding complications during dental procedures.

Spontaneous postoperative bleeding after periodontal procedure: An alarming sign of bleeding disorder

The prevalence of inherited bleeding disorders (BDs) is low in the general population (10-20 per 100,000 individuals), particularly hemophilia B cases, which may remain undiagnosed for a very long time until exposed to some surgical procedure. The dental professional must be aware of the possibility that patients with no previous history of abnormal bleeding may manifest their first bleeding episode in the dental office. Particularly as periodontists, we often encounter patients with bleeding gums and severe bleeding complications may precipitate while performing routine periodontal procedures. Hence, we must have a thorough knowledge of BDs and their management in challenging hemorrhagic situations. Management of such patients necessitates a multidisciplinary approach by involving the patient's hematologist and advanced laboratory facilities. The present case report is an attempt to discuss the diagnosis and management of a bleeding episode that occurred post periodontal flap surgery in an undiagnosed hemophilia B patient.

Desmopressin as a Treatment in Patients With Von Willebrand Disease: A Systematic Review

Von Willebrand disease (VWD) and hemophilia A are the most common inherited bleeding disorders. Quantitative or qualitative von Willebrand factor (VWF) anomalies cause this disorder in men and women. VWF, a plasma glycoprotein, relies on platelets for primary hemostasis. It also carries and stabilizes factor VIII in the blood. VWD has several categories. Types 1 and 3 have partial or total VWF quantitative deficiencies. However, type 2 and its subtypes have VWF quality issues. The major treatment is desmopressin (DDAVP), which replaces endogenous VWF and factor VIII (FVIII). Plasma-derived VWF/FVIII products may also be substituted exogenously. Treatment with plasma-derived or recombinant VWF concentrates without FVIII is also possible. The purpose of this retrospective, single-center research was to evaluate DDAVP's efficacy in treating VWD based on many criteria established in the current literature. We looked at the results on Google Scholar, the Cochrane Library, and PubMed/Medline. There were a total of 10 papers found, evaluated, and accepted for inclusion in this study. A comprehensive analysis of DDVAP's role in VWD was compiled from the aforementioned papers. Various aspects of DDVAP were captured by including an analysis of complementary treatments used in surgical and clinical settings. We also describe the treatment's intended impact on the different variations of the disease. Given these results, further investigation is required to determine the most effective method for managing VWD so that it may be included in standard clinical practice.

Delayed bleeding in a hemophilic patient after sinus floor elevation and multiple implant placements

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