Hereditary Blood Coagulation Disorders: Management and Dental Treatment

An Update on the Dental Management of Children with Haemophilia

Children with haemophilia present a bleeding risk and a challenge for dentists. Guidelines on the dental management of haemophilia patients are largely based on expert consensus. Many existing guidelines also provide generic guidance mainly for adult patients, which have been adapted for children. However, children have unique needs that require additional considerations. With limited evidence available, it is important that dentists have an understanding of the principles of both medical and dental management and have a close collaboration with the haematologist at all times. Therefore, this paper provides some key principles related to various aspects of dental management of children with haemophilia. Furthermore, there has been a recent update to the World Federation of Haemophilia (WFH) Guidelines for the Management of Haemophilia,¹ with references to novel medical therapies for haemophilia. Hence, this paper also aims to inform dentists with the standard and newer medical therapies for haemophilia, including a specific focus on the novel agent Emicizumab and the associated dental considerations.

Oral Health Status and Treatment Needs among Hemophilic Children in Hyderabad, Telangana, India

AIMS AND OBJECTIVES

The aim of this study is to evaluate and compare the dental caries stratus and treatment needs of hemophilic children with that of healthy and normal children.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted on 60 subjects with age ranging from 7-16 years attending and registering their names, residential address, parental occupation, and other criteria in Hemophilic Society at the Telangana state. The oral hygiene status was recorded by using oral hygiene index-simplified (OHI-S). Teeth affected by dental caries and teeth restored/extracted as sequale of dental caries were assessed using decayed, missed, filled tooth (DEFT) and DMFT for primary and permanent dentition, respectively.

STATISTICAL ANALYSIS

Data were analyzed by means of SPSS, version 21.0, and the Chi-square test and the Kruskal-Wallis test.

RESULTS

The mean oral hygiene index simplified scores were 1.28 in 7-9 years and 1.87 in 13-16 years, respectively. The mean DMFT + DEFT of 7-9 years was 4.76 and for 13-16 years was 3.11 highest mean DMFT + DEFT 4.76 was recorded in the 7-9 years age group.

CONCLUSION

The present study showed that oral hygiene status of hemophilic children was poor and treatment requirement was high among hemophilic children. The overall prevalence of dental caries was 73.3% and the treatment needs were 93.90%.

HOW TO CITE THIS ARTICLE

Reddy KS, Reddy NV, et al. Oral Health Status and Treatment Needs among Hemophilic Children in Hyderabad, Telangana, India. Int J Clin Pediatr Dent 2019;12(1):30-32.

Dental Management of a Child with Incidentally Detected Hemophilia: Report of a Clinical Case

Children with hemophilia (A or B) are at risk for bleeding episodes, which rank from mild mucosal/soft tissues bleeding to life-threatening hemorrhages. This report describes the dental/medical management provided to an 8.10-year-old patient suffering from uncontrolled bleeding after a surgical procedure to expose both permanent upper central incisors, in which hemophilia was a pure incidental finding. Additionally, diverse precautions to be considered during the dental clinical treatment of hemophilic children are discussed.

Dental extraction in patients receiving dual antiplatelet therapy

Background

Dual anti platelet therapy consists of administering antiplatelet (antiaggregant) drugs (clopidogrel and aspirin) to prevent thrombotic processes, as a preventative measure in patients with acute coronary disease, or in patients subjected to percutaneous coronary intervention.

Objectives

The purpose of this study was to evaluate the efficacy of a protocol for performing dental extraction in patients receiving dual anti platelet therapy.

Material and Methods

Thirty-two patients undergoing dental extractions were included in the study. The variables evaluated were: collagen-epinephrine fraction, collagen- adenosine diphosphate fraction, surgical surface, post-surgical measures, and adverse effects. Alveolar sutures and gauzes impregnated with an antifibrinolytic agent (tranexamic acid), which the patient pressed in place for 30 minutes, were applied to all patients as post-surgical measures. Descriptive statistics were calculated and analyzed with Student’s t-test to compare pairs of quantitative variables; simple regression analysis was performed using Pearson’s correlation coefficient. Statistical significance was set at p<0.05.

Results

Collagen/epinephrine fraction was 264.53±55.624 seconds with a range of 135 to 300 seconds, and collagen/ADP fraction was 119.41±44.216 seconds, both values being higher than normal. As a result of the post-surgical measures taken, no patients presented postoperative bleeding, hematoma or infection.

Conclusions

Dental extraction was safe for patients receiving dual anti-platelet therapy when using sutures and gauze impregnated with tranexamic acid, which the patient pressed in place for 30 minutes.

Key words: Aspirin, clopidogrel, tranexamic acid, dental extraction, platelet function.

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

Objective:

The objective of the following study is to evaluate freshly prepared tranexamic acid mouth wash (FTAMW) as an alternative to factor replacement therapy (FRT) in controlling gingival bleeding in hemophiliacs during dental scaling.

Materials and Methods:

Experimental treatment regime (ETR) involved saline transfusion followed by FTAMW and the control treatment regime (CTR) involved FRT followed by placebo mouthwash. A total of 22 hemophiliacs randomly received dental scaling under either CTR or ETR at two different visits, following a split mouth design. They were instructed to use the rendered mouthwash 4 times a day for 5 days and record the mouthwash usage and bleeding episodes in a logbook. The difference in the bleeding episodes was analyzed using Chi-square test with the level of significance predetermined at 0.05.

Results:

Totally 19 patients completed the study. Seven patients reported no bleeding either in ETR or CTR; five patients noticed bleeding in CTR, but not in ETR. Three patients noticed bleeding in ETR, but not in CTR. Patients reported ease in usage and cost-effectiveness of ETR.

Conclusion:

FTAMW was found to be an effective alternative to FRT in controlling gingival hemorrhage in hemophiliacs during dental scaling.

Successful management of bleeding after dental procedures with application of blood stopper: a single center prospective trial

AIM

Ankaferd Blood Stopper (ABS), as an herbal complementary medicine, has been approved for the management of clinical hemorrhages in Turkey, including dental interventions. Basic, preclinical and clinical studies disclosed the settings of the topical hemostatic use of ABS. The aim of this study is therefore to assess the efficacy and safety of ABS as an antihemorrhagic agent in the bleedings associated with dental procedures in patients with normal and impaired hemostasis.

MATERIALS AND METHODS

ABS has been topically applied by homogeneously spraying to the 113 patients during dental interventions within its on-label indications. A median of 0.5 ml (IQR:0.5-1 ml) ABS was administered after tooth extraction with prolonged hemorrhages.

RESULTS

After the administration, bleeding stopped in less than 10 seconds in 59 (52.2%) patients, and below 22.5 seconds (IQR: 18, 8-30) in 54 patients (47.8%). A total of 141 procedures were performed in these 113 patients, and nearly 72.5 ml ABS was used with a total cost of 98 €.

CONCLUSION

ABS as a new herbal medicine was found to be an effective method for controlling bleeding related to dental procedures. No patient had wound infection and the healing process appeared to be normal. Topical ABS could be useful for the local hemostasis and wound healing in periodontal surgeries.

CLINICAL SIGNIFICANCE

In this prospective study ABS, for the first time, has demonstrated its potential for being an effective hemostatic agent for the management of bleedings due to dental procedures.