Guidance on the dental management of patients with haemophilia and congenital bleeding disorders

Abstract

Recommendations for dental preventive strategies and treatment planning were originally developed through consensus meetings by the Scottish Oral Health Group for Medically Compromised Patients and published in 2003 as a Guideline. The United Kingdom Haemophilia Centre Doctors' Organisation (UKHCDO) Dental Working Party has updated these recommendations following the AGREE II approach (www.agreetrust.org), involving a literature search, a review of national and international guidelines and after seeking the opinions of haemophilia treaters in the United Kingdom by an online survey. Where possible, evidence from the literature is graded according to the 'GRADE' system (www.bcshguidelines.com/bsch_process/evidence_levels_and_grades_of_recommendations/43_grade.html); however, overall there is a lack of robust data and most studies have methodological limitations. The objective of this guidance, which is largely consensus-based, is to assist dental practitioners in primary and secondary care to provide routine dental care for patients of all ages with congenital bleeding diatheses in order to improve overall access to dental care. The guidance may not be appropriate in all cases and individual patient circumstances may dictate an alternative approach. Date for guideline review: May 2016.

Management of Various Bleeding Problems in Dental Patients: An Approach to Normal Hemostatic System and the Patient's Specific Coagulation Defect

“…For example, countries with a high income have the highest occurrence, which increases over time. Hemophilia A is inherited as an autosomal X linked recessive trait; therefore, the disease mainly affects males.16,17 However, females with a factor VIII activity level of less than 50% are considered to be carriers and are treated as patients with mild hemophilia (Anderson et al, 2013).…”

Nacionalna priporočila za obravnavo bolnikov s hemofilijo

“…zalivanje fisur, zdravljenje kariesa, predvidljivo endodontsko zdravljenje, odstranjevanje zobnih oblog nad dlesnijo, ortodontsko zdravljenje, protetična oskrba), nadomestno zdravljenje za dvik manjkajočega faktorja ni potrebno (73).…”

“…Za preprečitev bolečine se priporoča pred injekcijo anestetika v ligament ali papilo še bukalna infiltracijska anestezija (120,(123)(124)(125). Otroci na profilaktičnem zdravljenju naj prejmejo lokalno anestezijo takoj po rednem vbrizganju koagulacijskega faktorja, zato se obisk pri zobozdravniku uskladi z urnikom profilaktičnega nadomestnega zdravljenja (73). Lahko se uporabljajo vse vrste lokalnih anestetikov.…”

Di̇ş Heki̇mli̇ği̇ Açisindan Ri̇skli̇ Si̇stemi̇k Hastaliklar Ve Bu Hastaliklara Bağli Oluşabi̇lecek Aci̇l Durumlar: Bölüm 1 - Si̇stemi̇k Hastaliklar

“…Bu hastalarda lokal anestezi altında işlem yapılmasında herhangi bir sakınca yoktur. Ancak genel anestezi ve sedasyon esnasında özellikle oksijen taşıma kapasitesi düşük olan hastalarda solunumu baskılayan bazı sedatiflerin kullanılması risklidir 9,19 . Bu hastalarda lokal anestezi uygulamaları bile tehlikeli olabilmektedir.…”

“…Bu hastalarda lokal anestezi uygulamaları bile tehlikeli olabilmektedir. Bu nedenle müdahale mutlaka hastane ortamında yapılmalı, yukarıda bahsedilen gerekli ön-lemler alındıktan sonra bile derin dokularda hematom oluşturma riskinden dolayı mümkün olduğunca rejyonel anesteziden kaçınılmalı, infiltrasyon anestezisi tercih edilmelidir 1,18,19 . 4.…”