Dental Care for Patients with Bleeding Disorders, Including Hemophilia

Abstract

Background: Bleeding disorders, such as hemophilia and von Willebrand disease, pose significant challenges in dental management due to the increased risk of excessive bleeding. Proper pre-treatment evaluation, hemostatic measures, and postoperative care are essential to minimize complications. However, there is a lack of standardized guidelines and awareness among dental professionals, leading to variations in treatment approaches.

Aim: This study aimed to evaluate the dental management strategies for patients with bleeding disorders, focusing on treatment protocols, pre-treatment interventions, and post-procedural complications. The findings provide insights into optimizing dental care for this high-risk population.

Methods: A cross-sectional study was conducted at Sadar Hospital, Hajipur, Vaishali, Bihar, from May 2023 to October 2024. A total of 50 patients diagnosed with bleeding disorders underwent various dental procedures, including tooth extractions, scaling, restorations, and root canal treatments. Pre-treatment interventions, intraoperative management, and post-treatment complications were recorded. Statistical analysis was performed using SPSS version 23.0, with chi-square and independent t-tests applied for comparative analysis.

Results: The majority of participants were male (70%) and aged 18-40 years. Hemophilia A was the most prevalent bleeding disorder (50%), followed by von Willebrand disease (30%) and Hemophilia B (20%). Tooth extractions were the most commonly performed dental procedure (40%). Pre-treatment interventions included Factor VIII replacement (50%), desmopressin (30%), and tranexamic acid (20%). Post-treatment complications occurred in 20% of cases, with prolonged bleeding (12%) being the most frequent. A statistically significant association (p=0.03) was found between procedure type and complications, with extractions posing the highest risk.

Conclusion: The study highlights the importance of individualized treatment planning and pre-procedural interventions to minimize complications in dental management for patients with bleeding disorders. The use of factor replacement therapy and antifibrinolytics significantly improved patient outcomes, reducing bleeding-related risks.

Recommendations: Standardized guidelines should be established for dental management of patients with bleeding disorders, emphasizing pre-treatment risk assessment and interdisciplinary collaboration with hematologists. Dental practitioners should receive training on appropriate hemostatic measures and emergency protocols to enhance patient safety. Further research is needed to evaluate newer hemostatic agents and minimally invasive dental techniques for this patient population.

Keywords: Bleeding disorders, hemophilia, von Willebrand disease, dental management, hemostatic measures