The most important principle of dental management in patients with bleeding disorders is good oral hygiene and preventive care. Teeth should be brushed twice a day and teeth should be flossed once a day.

Regular professional dental care is encouraged

First dental visits normally occur between the second and third years of life. Earlier visits should be undertaken if there is evidence of dental problems or decay. A patient who has an implantable venous access device in place or has had any joints replaced should receive one dose of antibiotic prophylaxis (amoxicillin 2gms-adult, 50mg/kg-children; or other antibiotic if you are allergic to penicillin) by mouth one hour before the dental work (this would include cleaning, fillings and extractions).

Dental cleaning and scaling and the application of braces may cause slight oozing but factor concentrate, DDAVP or Amicar are seldom required.

Cavity repair

If there are dental cavities that need to be repaired, it is important to know about the use of numbing agents. Local or ligamentous numbing (around the side of the tooth) is the analgesic of choice, and factor concentrate or DDAVP/Stimate is recommended prior to the procedure. Amicar is also usually recommended for about seven days. Regional block anesthesia (numbing the entire side of the mouth) carries a higher risk of bleeding; it is recommended that you receive a larger dose of factor or treatment with DDAVP/ Stimate before the procedure. If factor or DDAVP is not given, a large hematoma at the side of the jaw can develop which may cause swelling of the throat and difficulty breathing. A second dose of factor concentrate is usually recommended 12-24 hours following the procedure as well as Amicar starting the day of the procedure.

Tooth extractions

For tooth extractions, factor concentrate or DDAVP must be given before the procedure. Factor concentrate or DDAVP may need to be repeated in 12-24 hours depending on the number of extractions and the degree of tissue trauma. Amicar is given on the day of extraction and for about 10 days afterwards. A strict diet of cool liquids for several days helps stabilize clots.

Drinking from a straw or smoking should be avoided to prevent the formation of dry sockets.

Sometimes an oral rinse of Amicar is used to manage oral bleeding. This may be used in addition to or instead of Amicar that is swallowed by mouth.

It is important that you speak with your hemophilia nurse coordinator regarding the dosing of factor/ Stimate or DDAVP and Amicar prior to the dental procedure.