Bleeding from the mouth in a person with a bleeding disorder can be difficult to control and may require a trip to the emergency room or a visit to the hematologist’s office. Here are some useful tips that may help with this problem.

Common causes of bleeding from the mouth

• Teething or loss of baby teeth
• Extraction of permanent teeth, particularly wisdom teeth
• Dental procedures such as cleaning, root canals and crowns
• Periodontitis or gum disease
• Trauma to the tongue, frenulum or cheek usually from the person's own teeth

Why can oral bleeding be worrisome?

Often the amount of blood loss is not great, but oral bleeding may last for several days and result in anemia. Healing is more difficult in the mouth, and the sucking that young children naturally do complicates it. Many times, the bleeding is controlled and then restarts when the child eats, sucks, etc.

Standard treatment for oral bleeding

We try to limit, if possible, sucking, the use of pacifiers, etc. Sharp foods, hot drinks, flossing and other trauma to the mouth should be avoided during the healing process. Amicar can be used at a dose of 50-100 mg/kg/dose four times per day. This is a medicine that inhibits the enzymes in the saliva that naturally break down blood clots. Factor concentrate or DDAVP may also be necessary depending on the underlying bleeding disorder but should only be used after contacting your hematologist.

Level of risk with oral bleeding

Oral bleeding tends not be nearly as bad as it looks. Often, one little place on the gum will be oozing, but because it never stops, there is a steady trickle. Oral bleeding is usually not a life-threatening bleed, unless the person has a traumatic accident that results in severe swelling in the mouth or throat area, which could lead to respiratory distress. However, there are instances where a child might have an oral bleed, and the parent will not know it because the child is continuously swallowing the blood. In these cases, the child may become nauseated by blood that is swallowed and will throw-up blood or it will show in his stool. This can be very confusing to diagnose and frightening for those who see it.

If there are any questions about a mouth bleed or if you or your child has one that does not stop quickly, contact your physician for advice.