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HEMOPHILIA & DENTAL CARE

Why See a Dentist Wisdom Teeth
First Teeth Save Your Gums
Ages 6-13 911 Mouth Bleeds
Teen Years Dental Check Ups
 

Good dental care is important for everyone, but it is particularly important for people with hemophilia. Oral health impacts overall health, making it even more critical for people with hemophilia to have good dental habits.

Often times families dealing with hemophilia have so much on their plate that dental care often falls to the bottom of the list. But it needs to be given a much higher priority, because it’s so important to health overall. Ideally, dental care should start early, when the child is young and a good preventive program can be put into effect.

A patient recently who needed thousands of units of factor concentrate just to have his teeth cleaned. If he had taken care of his teeth and gone to his dentist for regular check ups, this would never have happened.

Having a dental home is essential, so if you have a crisis or an accident, you’re already evaluated and set up. An accident is not a good way to meet someone for the first time. People with hemophilia need a dentist to help them manage a variety of dental issues, from infection and extraction of baby teeth and wisdom teeth to treating infected and cracked teeth, and of course, periodontal or gum disease.

Then make sure your dentist contacts your HTC to obtain essential information about your hemophilia. Inform the dentist if you’re on prophylactic therapy and how you treat a minor bleeding episode

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Communication should be two-way. Dentists are responsible for telling patients about the risks of any procedure, especially the administration of local anesthetic. Because the injection sometimes needs to be given back in an area with major blood vessels, patients should understand the risk beforehand

Regular visits mean you’ll deal with small issues rather than large ones. It pays for itself because you’re not dealing with the emotional and financial costs of emergency root canals or extractions

What you do in between visits makes all of the difference between a healthy mouth and dental problems. Brushing and flossing are important for everyone, but neglecting these basics has a more profound impact on people with hemophilia.

The roots of the teeth are surrounded by bone, which is covered by soft tissue known as the gingival, or gums. If gum disease, or gingivitis, occurs, spontaneous bleeding is one of the first signs. This is a much more difficult problem for people with hemophilia, because they’ll bleed longer. It’s why maintaining healthy gums and minimizing exposure to periodontal disease is very important. To prevent gum disease, you need to brush your teeth and floss regularly. Sometimes, people with hemophilia fear that brushing and flossing will result in mouth bleeds

Healthy gums do not generally bleed during brushing and flossing, even in the person with hemophilia,. The only time some bleeding might occur is if you’re overly aggressive with the toothbrush when brushing.

However don’t stop brushing, because that bleeding is likely caused by plaque, and you definitely want to scrub that off. Be aware that if bleeding continues for more than 20 minutes or stops and then starts again, it’s time to call your hemophilia treatment center. Bleeding gums are a sign of dental disease. Treating with factor concentrate or other therapies may temporarily stop the bleeding, but not the disease, so please see your dentist . The gums might bleed slightly when you begin regular flossing. It usually will stop within a week, if flossing is kept up every day, and does not usually require treatment with factor concentrate. As plaque is removed and gums get healthier, bleeding will decrease. You should contact your HTC if you have any concerns about continued bleeding because plaque causes both cavities and periodontal disease, flossing is essential. The good news is that once-a-day, thorough plaque removal can help you prevent dental disease, keep a healthy smile, and protect your teeth for a lifetime.

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Through the Years

From the first baby tooth through braces and beyond, how does hemophilia affect dental care needs? Below is a rapid tour through the growing years that highlights what you’ll need to know.

First Teeth
Baby teeth come in when the child is between six and ten months old. By the age of three years, children have all 20 baby teeth. Teething rarely causes bleeds, but if minor bleeding or oozing from the gums occurs, contact your hemophilia treatment center. Due to the moistness of the mouth, blood clots cannot form as easily and might fall out before a cut is healed. If your baby has persistent mouth bleeds, your HTC can prescribe a product that helps clots stay in the mouth.

Toddlers are very active, which can mean trauma to the mouth, tooth bleeds, and cheek and lip bleeds. Parents are encouraged to use an antifibrolytic agent for oral or mucosal bleeding, and a commercially available fibrin collagen material that can be placed right on the bleeding area to stop the bleed. These two treatments can be used right through the tooth-losing and -erupting stages.

Excessive bleeding might also be treated with an extra dose of factor concentrate or desmopressin nasal, depending on the bleeding disorder.

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Tooth Fairy Years (6-13)
During these years, children can start taking more responsibility for their own dental hygiene, but they still need supervision and guidance to reinforce and maintain good habits.

During the early years, when tooth roots are mobile, there can be some mouth bleeding. That’s when an antifibrolytic agent comes in handy.

When adult teeth begin to replace baby teeth, the experts say that you should let the baby teeth fall out naturally, without pulling, so less bleeding will occur. More effort might be needed in some cases, so we encourage children to take out the teeth on their own if they’re wiggly. If bleeding occurs when a tooth falls out or is extracted by a dentist, first have the child bite gently on a gauze pad or moist tea bag. If bleeding continues,  put a treatment plan in place that can include an infusion of factor concentrate and an antifibrolytic agent.

Nearly half of the permanent teeth come in by age ten. Children might experience bleeding or oozing when teeth erupt. Dental professionals advise parents to apply firm, gentle pressure to the area and use an antifibrolytic agent, if necessary.

Afterwards, treat your child to soft, cool foods like yogurt, avoid serving hot foods, and avoid using straws. These simple measures will help preserve the blood clot until the area heals.

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Brace Yourself
The teenage years bring many changes, sometimes including the need for braces. The good news is that children with hemophilia can wear braces just like everyone else.

If applying braces requires tooth extractions or any other kind of orthodontic surgery, have it done. Just be sure to consult with your HTC and dentist first to determine what kind of pretreatment is needed.

Placing braces does not cause bleeding in most cases. But let the orthodontist know about your child's hemophilia so that special care can be taken to avoid cutting or irritating the gums when bands and wires are placed on the teeth. You also can learn how to apply dental wax over rough edges to protect gum tissue, cheeks, and lips.

The only real difference for teenagers with hemophilia is the increased emphasis on thorough daily hygiene habits. Having braces can be a double whammy for them because of their increased susceptibility to dental problems. If they don’t take care of their teeth, their gums will bleed, and they’ll bleed longer.

In addition to brushing, use a fluoride rinse every day and conducting a daily finger check to make sure no wires are sticking out or poking into the gums.

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Teeth of Wisdom
The last teeth to appear, wisdom teeth or third molars, usually begin to erupt at age 17. Because these teeth cut through the gums, people with hemophilia can experience prolonged bleeding and might need an antifibrolytic agent or desmospressin nasal.

If the teeth aren’t in the right position or your jaw is too small to accommodate them, they may become impacted and need to be extracted. This procedure should be planned out with your dentist or oral surgeon and HTC. You should be fully informed about what will happen before, during, and after the procedure. Dental extractions require treatment with factor and an antifibrolytic agent.

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Save Those Gums
As you age, periodontal (gum) disease becomes a greater risk. In fact, more than 75 percent of people over age 35 have some form of this disease, which can lead to tooth loss and, in people with hemophilia, more bleeding. Continuing to follow a sound dental hygiene program will help prevent gum disease or enable your dentist to catch the disease in its early, more curable stages. If dentures become the only solution, make sure they fit properly. “Poorly fitted dentures can rub against the gums, and may cause problems when you eat,” says Ridley.

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Note: Hemophilia Galaxy does not recommend a particular treatment for specific individuals and recommends that you consult your hemophilia treatment center or physician before pursuing any course of treatment. Use of antifibrolytic agents is not recommended for inhibitor patients using Factor VIII bypassing therapy, due to the increased possibility of thrombotic risk.

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The 9-1-1 on Mouth Bleeds

bulletAs hard as you try, accidents involving the mouth may happen, especially during childhood. When bumps, falls, and collisions occur, here’s what to do:
bulletSave a knock out: Pick up the tooth by the crown, avoiding the roots, rinse it off, and place in milk, if possible. Hurry to a dentist or emergency room; they might be able to reinsert the tooth. On the way, apply firm pressure to the bleeding site with a piece of clean gauze.
bulletGo directly to the emergency room if: bleeding on the tongue, cheek, or floor of the mouth doesn’t stop; the tongue, throat, or neck is swollen or bruised; or your child is having trouble breathing or swallowing.
bulletTake control: Prevent the clot from breaking away from the wound site after an injury or extraction with treatment that can include an antifibrolytic agent, factor concentrate, or desmopressin nasal.
bulletA word to the wise about preventing emergencies: Children with hemophilia should always wear mouth guards when they play sports.

Note: Hemophilia Galaxy does not recommend a particular treatment for specific individuals and recommends that you consult your hemophilia treatment center or physician before pursuing any course of treatment. Use of antifibrolytic agents is not recommended for inhibitor patients using Factor VIII bypassing therapy, due to the increased possibility of thrombotic risk.

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Dental Check up

The following is a short list of essentials to keep in mind when you plan a visit to the dentist:

bulletYour doctor may recommend that you take antibiotics before all invasive dental procedures if you’ve had a joint replaced or have a central venous line (port).
bulletIf you’re experiencing prolonged bleeding after teeth cleaning, work with your dentist and hemophilia treatment center to plan further treatment.
bulletOral surgery and periodontal treatments are more complex for the person with hemophilia. Pre-treatment with factor concentrate or short-term hospitalization may be required. Careful planning with the oral surgeon and your HTC before treatment will decrease the likelihood of bleeding difficulties afterwards. Any sort of heavy manipulation of gum tissues, such as in an extraction, may require pretreatment with an antifibrolytic agent and possibly an infusion of factor concentrate.
bulletLocal anesthesia is safe if planned carefully. Be sure to work with your dentist and HTC to determine whether you need to pre-treat with factor concentrate. However, at IHTC, we don’t recommend block injections without use of factor concentrate for routine use,.
bulletIf you are following a prescribed prophylaxis regimen, schedule your dental visits on the days that you treat.

Note: Hemophilia Galaxy does not recommend a particular treatment for specific individuals and recommends that you consult your hemophilia treatment center or physician before pursuing any course of treatment. Use of antifibrolytic agents is not recommended for inhibitor patients using Factor VIII bypassing therapy, due to the increased possibility of thrombotic risk.

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What your dentist needs to Know

Informing your dentist that you have hemophilia before beginning any procedure is the first step. Below is other essential information that will help your dentist plan the correct course of treatment:
bulletThe type and severity of your hemophilia
bulletThe medications you take
bulletWhether pre-treatment with factor concentrate, desmopressin nasal or an antifibrolytic agent is required
bulletYour HTC contact information
bulletWhether you have:
bulletAn inhibitor
bulletAny infectious diseases, such as hepatitis
bulletJoint replacement
bulletVenous access device (port)

Note: Hemophilia Galaxy does not recommend a particular treatment for specific individuals and recommends that you consult your hemophilia treatment center or physician before pursuing any course of treatment. Use of antifibrolytic agents is not recommended for inhibitor patients using Factor VIII bypassing therapy, due to the increased possibility of thrombotic risk

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Resource:http://www.hemophiliagalaxy.com/index.html

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