Table 3.64.
Key considerations for dental management in haemophilia (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 3 | Haemorrhage; Hazards of anaesthesia; hepatitis, liver disease and HIV infection; anxiety |
| Appropriate dental care | 3/4 | Factor replacement; desmopressin; tranexamic acid |
| Pain and anxiety control | ||
| – Local anaesthesia | 2 | Avoid regional blocks and lingual infiltrations |
| – Conscious sedation | 2 | Avoid IV sedation |
| – General anaesthesia | 3/4 | Assess joint involvement, mobility; avoid nasal intubation |
| Patient access and positioning | ||
| – Access to dental office | 1 | Joint involvement |
| – Timing of treatment | 1 | 1 hour after factor replacement |
| – Patient positioning | 1 | Joint involvement |
| Treatment modification | ||
| – Oral surgery | 3/4 | Factor replacement; minimal trauma; topical haemostatic agents; avoid catgut |
| – Implantology | 5 | |
| – Conservative/Endodontics | 2 | Avoid local bleeding; intracanal LA with epinephrine |
| – Fixed prosthetics | 2 | Avoid local bleeding |
| – Removable prosthetics | 1 | |
| – Non-surgical periodontology | 3/4 | Factor replacement; topical haemostatic agents |
| – Surgical periodontology | 3/4 | See oral surgery |
| Imaging | 1 | Do not rest radiographs on the floor of the mouth |
| Hazardous and contraindicated drugs | 2 | Avoid aspirin, indometacin and other NSAIDs; avoid intramuscular injections |
*
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.