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.
