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Healthy mouths are happy mouths

Good dental care is important for everyone, but it is particularly important for people with hemophilia. Oral health impacts overall health, making it even more critical for people with hemophilia to have good dental habits. Dental care should start early, when you are young. But it is never too late to begin taking care of your teeth and gums.

Going to the Dentist

Having a dentist who knows you and your circumstances is essential. It is also just as important to make sure that your dentist communicates with your Hemophilia Treatment Center (HTC) so that everyone is on the same page. Things your dentist needs to know:

• Type and severity of your bleeding disorder
• Presence of any infectious diseases (such as Hepatitis and HIV)
• If you have an inhibitor
• What medications do you take (including prophylactic factor)
• How do you treat your mouth bleeds
• The pre-treatment protocol you require before dental procedures
• Presence of a vascular access device
• If you have a heart murmur
• Contact information for your HTC

Brushing and Flossing

Brushing and flossing are important for everyone, but not doing these basic steps to keep your mouth healthy can have a greater impact on people with hemophilia.

Sometimes people with hemophilia are afraid to brush or floss their teeth because it will lead to mouth bleeds. Healthy gums do not generally bleed during brushing and flossing, even in a person with hemophilia. Bleeding is usually the result of the presence of plaque or gum disease, which causes gum swelling and irritation. However, bleeding can happen if you are overly aggressive in your brushing technique. Treating with factor or other therapies may temporarily stop the bleeding, but not the gum disease. This is the time to see your dentist and talk to your HTC. It is not, however, time to stop brushing and flossing.

Your gums might bleed slightly when you begin flossing at first. It usually will stop within a week, if flossing is kept up every day. As plaque is removed and gums get healthier, bleeding will decrease. You should contact your HTC if you have any concerns about bleeding that continues even with regular brushing and flossing, bleeding that lasts longer than 20 minutes, or stops only to restart a short time later.

Preventing tooth decay, gum disease and cavities:

• Brush and floss your teeth consistently
• Limit in between meal snacks if you cannot brush
• Rinse your mouth after eating if you cannot brush
• Discuss fluoride needs with your dentist
• Talk to your dentist about sealants – typically applied to baby teeth and permanent molars
• Use a toothbrush with soft to medium rounded bristles
• Start flossing with the correct technique early on

Baby teeth typically come in between six and ten months old. By the age of three, children should have 20 primary teeth. Eruption of primary teeth may cause some oozing of blood. Due to moistness in the mouth, stable blood clots cannot form as easily and might fall out before a cut is healed. For persistent mouth bleeds talk to your HTC about products to help stabilize a clot.

Toddlers are very active, which can mean trauma to the mouth, tooth bleeds, and cheek and lip bleeds. Make sure you have a game plan with your treatment center before this stage occurs. Having a treatment plan can help decrease the anxiety of a bleed if you know how to react.

Preventing bleeds

• Provide soft toys
• Use a plastic or rubber coated utencils
• Start teaching children early on not to walk or run with things in their mouths
• Working to have them chew food slowly helps limit biting cheeks and tongue
• Examine inside of mouth after a fall and manage bleeds as taught

Steps to help teething go more smoothly

• Provide supervised soothing cold things to suck and bite on (soft rubberized teethers, a frozen bagel, a cold, clean washcloth)
• Gentle pressure with a clean cloth or gauze if there is oozing
• Rubbing the area with a clean finger
• Over-the-counter numbing ointments as instructed
• Talk about non-aspirin pain relievers with your treatment center

Start brushing early

• Use a moist gauze or clean cloth
• Use a soft toothbrush
• Use fluoride toothpaste once old enough to rinse and spit (no swallowing)

Knocked out or chipped tooth

• Rinse tooth and place in milk if possible
• Apply pressure to bleeding site and keep it moist
• Get to dentist or emergency room as soon as possible

Basic first aid

• Apply pressure with clean cloth or gauze to area of bleed
• Protect the new clot until healed:
  • Soft, cold, or room temp foods
  • Brush gently or use a Q-tip
  • Avoid having child using pacifiers and straws (sucking can dislodge clot)

Calling your treatment center

• Bleeding in the mouth that does not stop
• Swelling or bruising in the tongue, throat or neck
• Any trouble swallowing or breathing

From about the age of 6 on, children can take a more active role in their oral hygiene. But it is still important to supervise them to ensure that are doing it correctly and safely. The goal is to reinforce healthy habits.

This is also when adult teeth begin to replace baby teeth. Nearly half of the permanent teeth come in by age ten. Where ever possible allow the tooth to fall out naturally (there will be less bleeding than if it is pulled or extracted).  If the tooth is wiggly and your child pulls it out, there may be some bleeding. Children might experience bleeding or oozing when teeth erupt. Dental professionals advise parents to apply firm, gentle pressure to the area and follow a treatment plan for mouth bleeds where appropriate. Following a lost or newly erupted tooth, treat your child to soft, cool foods like yogurt and avoid serving hot foods and using straws. These measures will help keep the blood clot in place until the area heals.

• Reinforce brushing and flossing
• Schedule regular check-ups
• Talk to dentist about sealants and fluoride needs
• Eat a healthy diet
• Have a treatment plan for bleeds related to new teeth or lost teeth
• Teach your child how to react if a tooth is chipped or knocked out
• Talk to teachers and educators about managing your child’s mouth bleeds and dental emergencies
• Encourage using protective gear required for certain sports and activities

Knocked out or chipped tooth

• Rinse tooth and place in milk if possible
• Apply pressure to bleeding site and keep it moist
• Get to dentist or emergency room as soon as possible

Basic first aid

• Apply pressure with clean cloth or gauze to area of bleed
• Protect the new clot until healed:
  • Soft, cold, or room temp foods
  • Brush gently or use a Q-tip
  • Avoid having child using straws (sucking can dislodge clot)

Calling your treatment center

• Bleeding in the mouth that does not stop
• Swelling or bruising in the tongue throat or neck
• Any trouble swallowing or breathing

Teenagers may need braces. The good news is that children with hemophilia can wear braces just like everyone else. Talk to your dentist and orthodontist about the procedure beforehand so that you understand what is required. Then consult with your HTC to determine what kind of pretreatment is needed.

Getting braces does not cause bleeding in most cases. Your orthodontist should take special care special care to avoid cutting or irritating the gums when bands and wires are placed on the teeth. Also ask to be taught how to apply dental wax, which will help minimize cutting your cheeks, tongue and gums.

Braces

• Discuss the use of a fluoride rinse
• Brush daily as you have been taught
• Do a daily finger check to make sure that there are not any wires poking out

Basic first aid

• Apply pressure with clean cloth or gauze to area of bleed
• Protect the new clot until healed:
  • Soft, cold, or room temp foods
  • Brush gently or use a Q-tip
  • Avoid having teen using straws (sucking can dislodge clot)

Calling your treatment center

• Bleeding in the mouth that does not stop
• Swelling or bruising in the tongue throat or neck
• Any trouble swallowing or breathing

Knocked out or chipped tooth

• Rinse tooth and place in milk if possible
• Apply pressure to bleeding site and keep it moist
• Get to dentist or emergency room as soon as possible

Wisdom teeth 


Wisdom teeth, or third molars, usually begin to erupt at age 17.  Due to the shape and size of these molars, people with hemophilia may experience noticeable, prolonged bleeding. Talk to your treatment center about a strategy for management and treatment.

Dental Surgical Extraction

There are a variety of reasons teeth may need to be removed. If the teeth aren’t in the right position or your jaw is too small, they may become impacted. Bleeding is always anticipated with this type of procedure and should be planned out with your dentist, oral surgeon and HTC.

Continuing consistent, effective oral hygiene is critical as you age. Gum disease is far more prevalent in adults.

Preventing tooth decay, gum disease and cavities

• Limit in between meal snacks if you cannot brush
• Get enough fluoride (talk to dentist early on to determine what is enough)
• Use soft to medium rounded bristles on your toothbrush
• Have your dentist review correct flossing and brushing techniques
• Get regular check-ups and cleanings
• Never share toothbrushes
• Replace toothbrushes as instructed

Dentures

Removal or loss of teeth with aging may create the need for dentures. Again, people with hemophilia can be fitted for dentures, but there are steps to follow to continue to keep your mouth healthy.

• Rinse dentures after eating
• Bring dentures to check for proper fit with your regular checkups. If they do not fit well, they can rub and cause bleeding.
• Soak dentures in a solution that will remove bacteria

Dental Check-ups

The following is a short list of essentials to keep in mind:

• Your doctor may recommend that you take antibiotics before all invasive dental procedures if you’ve had a joint replaced, have a central venous line (port) or have a heart murmur. Alert your dentist to this and take the antibiotics as ordered by your physician.
• If you experience prolonged bleeding after teeth cleaning, work with your dentist and hemophilia treatment center to plan further treatment.
• Oral surgery and periodontal treatments are more complex for a person with hemophilia. Pre-treatment with factor concentrate or short-term hospitalization may be required. Careful planning with the oral surgeon and your HTC before treatment will decrease the occurrence of bleeding difficulties afterwards.
• Plan ahead for dental extractions and dental surgery. Your HTC will work with you to provide a treatment plan that instructs you regarding factor pretreatment and antifibrolytics as appropriate.
• If you are following a prescribed prophylaxis regimen, schedule your dental visits on the days that you treat.