Dental procedure challenges for patients with haemophilia: Overcoming trauma with prophylaxis

Dr K K Radhika MD, Clinical Hematology, CMC Vellore, Associate professor, Department of Clinical Hematology, Nizam’s Institute of Medical Sciences explains why prophylactic therapy reduces the trauma of dental procedures in patients with haemophilia

Sara has been living with haemophilia A since childhood. She has faced several challenges during her disease journey, some of which have been associated with medical procedures such as dental treatments. She vividly remembers a tooth extraction that resulted in prolonged bleeding and multiple follow-up appointments. These experiences made her dental health a constant concern, and she often postponed or avoided dental visits. Recently, Sara was shifted to a prophylactic treatment for haemophilia which made it easier for her to undergo dental procedures. She underwent a dental filling and a minor gum procedure with minimal bleeding and minor discomfort

Haemophilia is a rare genetic bleeding disorder that affects the blood’s ability to form clots. People with this condition experience prolonged bleeding, both internally and externally, even from minor injuries. It predominantly affects males, but women can be carriers. Patients with haemophilia have low levels of either factor VIII (haemophila A) or factor IX (haemophilia B). Haemophilia A is about four times more prevalent than hemophilia B, with roughly half of the affected individuals experiencing the severe form of the disorder.ⁱ Nearly 400 babies are born with haemophilia A each year.ⁱⁱ It is estimated that India could have around 80,000 to 100,000 individuals affected by severe haemophilia. However, only 19,000 cases are registered with the Haemophilia Federation India (HFI).ⁱⁱⁱ

Haemophilia frequently goes unnoticed, especially in areas with restricted healthcare accessibility or inadequate awareness. Some of the common symptoms include large bruises after minor injuries, joint pain from internal bleeding, nosebleeds, and unusual bleeding after a surgery or dental treatment.^iv,v

Dental distress

Patients with haemophilia face significant challenges during medical procedures, including dental surgery. Due to their condition, routine dental procedures can cause soft tissue trauma which can lead to prolonged bleeding. There have been instances where haemophiliac patients have experienced fatal hemorrhage after receiving local anesthetic injections. This heightened vulnerability to bleeding contributes to fear and anxiety among the patients.

For surgical interventions, careful planning is essential to minimize bleeding. Prior to commencing treatment, the patient’s hematologist should be consulted regarding factors such as clotting levels, the administration of factor replacements, the nature of the surgery, and the need for systemic hemostatics. Stringent infection prevention measures need to be implemented. Proper positioning of sutures can aid in clot formation after surgery. Crafting a surgical stent can safeguard the surgical site during the healing process.^vi

To manage bleeding episodes, the World Federation of Hemophilia (WFH) recommends the use of on-demand factor VIII infusions. The treatment for haemophilia is transitioning to prophylactic or preventive therapy to proactively prevent instances of bleeding, as opposed to addressing bleeds. Prophylactic treatment can help maintain stable and adequate levels of the clotting factors in the blood, promoting healing and aiding in faster and smoother recovery. It represents a transformative approach in dental surgery by significantly reducing bleeding risks, enhancing surgical planning, and contributing to a more favorable surgical outcome, ultimately improving the patient’s quality of life. Thus, prophylactic therapy in haemophilia not only promotes patient safety and well-being but also efficiently utilises healthcare resources.

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