Routine dental work safe in hemophilia patients with clotting factor boost
Review: Increase to 30% to 50% of normal helps prevent excessive bleeding
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- Boosting clotting factor levels to 30-50% of normal helps make routine dental work safe for hemophilia patients.
- This factor boost, plus antifibrinolytic medicines, prevents excessive bleeding during dental procedures.
- Further research is needed to standardize clotting factor dosing for dental management in hemophilia.
Dental treatments can be performed safely in people with hemophilia when proper medical precautions are followed, according to a review of studies worldwide.
Most studies reported that raising the dose of factor replacement therapies to 30% to 50% of normal before treatment helped prevent excessive bleeding. With this protection in place, common dental procedures like fillings and teeth cleaning were safely performed using standard dental techniques.
While the findings were encouraging, researchers said the overall quality of the studies was low to moderate, and there was considerable variability in the dosage of clotting factors given.
This “underscores the importance of conducting larger, prospective clinical studies to better understand the rationale behind clotting factor use and its effects on dental treatment outcomes in patients with varying degrees of hemophilia severity,” the authors wrote.
The study, “Evidence-based dental management strategies for individuals with congenital hemophilia: a systematic review,” was published in BMC Oral Health.
There are no established guidelines for dental treatment in hemophilia
Hemophilia is a rare disorder marked by a lack of blood-clotting factors, which increases the risk of excessive bleeding that lasts an unusually long period of time. The main treatments for hemophilia are factor replacement therapies that provide a functional version of the missing clotting factor.
Because of this risk, routine dental work, such as procedures like cleanings, fillings, root canals, or tooth extractions, can lead to prolonged bleeding if not appropriately managed. As a result, people with hemophilia often exhibit poor oral health, attributed to disease-specific barriers and a fear of dental procedures.
There are, however, no established guidelines for dental treatment in hemophilia, with protocols varying widely across countries. Research suggests that this has led to reluctance among dental care professionals to perform procedures on people with hemophilia.
To learn more, researchers in India conducted a review of 23 published studies, including three randomized clinical trials, to provide an overview of dental procedures performed in people with mild to severe hemophilia and the use of factor replacement therapies. The different studies were conducted in the U.S., the U.K., Europe, Asia, Australia, and Africa.
Dosage of clotting factors given during dental procedures varied
Overall, an analysis rated the studies’ quality as either lower or moderate, primarily due to weaknesses in their design. For example, many did not clearly explain how preventive (prophylactic) clotting factor doses were calculated, and follow-up times after treatment were reported inconsistently.
Most studies showed that raising clotting factor levels to 30% to 50% of normal made dental treatment much safer for people with hemophilia. With this level of protection, routine dental care, such as fillings and teeth cleaning, was performed safely. Even so, there was considerable variability in the dosage of clotting factors given during various dental procedures.
Tooth extractions were usually performed safely with local anesthesia (numbing injections into the gums). However, nerve block injections (deeper anesthesia) carried a higher risk of bleeding, so clotting factors must be given beforehand to reduce this risk, the researchers noted.
Medicines that prevent blood clots, such as tranexamic acid and epsilon-aminocaproic acid, helped maintain a balance in blood clotting when factor replacement therapies were used. Together, these medications often lowered the need for extra clotting factor infusions after a dental procedure.
The findings of this review demonstrate considerable variability in the dosage of clotting factor administered during various dental procedures in individuals with hemophilia.
Still, prolonged bleeding after a procedure was the most common complication. In some cases, local bleeding-control agents (placed directly in the mouth) proved inadequate to stop bleeds after treatment, and further blood transfusions were required.
One study recommended routine maintenance appointments to assess oral hygiene, perform scaling, and apply topical fluoride without prior plasma clotting factor infusion.
“The findings of this review demonstrate considerable variability in the dosage of clotting factor administered during various dental procedures in individuals with hemophilia,” the researchers wrote. “Therefore, there is a need for further evidence-based, prospective clinical studies focusing on the dental management of patients with congenital hemophilia, along with documented clinical outcomes, to establish standardized recommendations for clotting factor concentrate dosing to ensure the safety of dental interventions.”
