Dental Health in Children with Hemophilia

Published on: 08/10/2018

What is hemophilia?

Hemophilia is a bleeding disorder, which slows down the blood clotting process. It is an X-linked recessive trait meaning that the defective gene is located on the X chromosome.

How does hemophilia affect the oral health of children?

Children with hemophilia may present excessive bleeding to inadvertent trauma of perioral soft tissue or after some dental procedures.

Oral manifestations of hemophilia

Hemophilia can manifest itself through:
  • Petechiae and ecchymosis, hematomas of the tongue, mucosa and hard palate.
  • Generalized spontaneous gingival bleeding
  • Hemorrhage in the temporomandibular joint (TMJ).

Dental Management and Prevention

Prevention is essential in managing the dental health of the child with hemophilia. Scheduling the child for early professional dental examinations is recommended.

Tips for Proper Dental Hygiene

  • Consult with your primary care physician or hematologist prior to your dental appointment.
  • Promote preventive dental practices to reduce the need for future dental restorations.
  • Apply topical fluoride and visit the dentist every 6 months.
  • Parents should begin brushing when the first baby tooth erupts and should assist their child in brushing until the child reaches 8 years of age.
  • Use fluoridated toothpaste; for children under 3 years old use a smear amount of fluoridated toothpaste and for children above 4 years old use a pea size amount.
  • Parents should monitor dietary practices (i.e. avoid prolonged use of bottle, reduce amounts of sugar consumed, reduce frequency of sugar consumed).

Preparing a child with hemophilia for a Dental Appointment

Discuss the medications currently being taken with the child's dentist. A medical clearance from the child’s physician or hematologist might be needed before treatment. Follow the instructions regarding any medications that need to be given prior to the dental cleaning or treatment; these medications might help improve the child’s blood clotting ability.

Conscious sedation may be considered if local anesthesia is contraindicated. Gingival trauma should be minimized during treatment. Hospitalization may be considered if invasive dental treatment is required.


Kaitlyn Purcell, DDS - Nicklaus Children's Pediatric Dentistry Residency Program

References

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Berlocher W, King D. Consideration in the dental management of the factor VIII – deficient child with inhibitors. The American Academy Pedodontics 1979;1(3):188-191.

Finucane D, Fleming P, Smith O. Dentoalveolar Trauma in a Patient With Chronic Idiopathic Thrombocytopenic Purpura: A Case Report. Pediatr Dent. 2004;26:352-354

Sanders B., Sheller B. Hematologic Disorders. In: Nowak A., Casamassimo P., eds. The Handbook of Pediatric Dentistry. 4th ed. American Academy of Pediatric Dentistry; 2001:257-259.

Genetic Home Reference. NIH U.S. National Library of Medicine. Available at:. https://ghr.nlm.nih.gov/condition/hemophilia Accessed: 2017-10-28. 

MedlinePlus. NIH U.S. National Library of Medicine. Available at: https://medlineplus.gov/ency/article/001304.htm. Accessed: 2017-10-28.

NIH National Human Genome Research Institute. Available at: https://www.genome.gov/20019697/learning-about-hemophilia/. Accessed: 2017-10-28. 

Pediatric Dental Study Guide. pediatricdentalstudyguide.weebly.com. Available at: https://drive.google.com/file/d/0B9RYUilcdGfHOF9QNHU4SGdMZXM/view. Accessed: 2017-10-28.

Genetic and Rare Disease Information Center. NIH National Center for Advancing Translational Sciences. Available at: https://rarediseases.info.nih.gov/diseases/6591/hemophilia-a. Accessed: 2017-10-28.


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