How do Hemophilia A and B affect dental management?
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How do Hemophilia A and B affect dental management?
Prevention first: aggressive hygiene, fluoride and sealants reduce the need for invasive care
Local anesthesia: buccal infiltration and intraligamentary injections are lower-risk alternatives. Inferior alveolar, superior alveolar, and floor-of-mouth or vascular lingual injections require preoperative systemic hemostatic measures agreed with hematology to prevent hematoma. WFH recommendations 2.7.10–11.
Isolation: rubber dam with careful clamp placement.
Tooth prognosis: preserve a restorable tooth when the pulpal diagnosis and prognosis support it. Do not retain an infected, nonrestorable tooth solely to avoid extraction.
Extraction: hematology-directed hemostatic support, gentle technique, local hemostatics (gelatin sponge, oxidized cellulose, sutures), and tranexamic acid rinse or tablets. WFH recommendations 2.7.7–9.
Analgesia: acetaminophen is the usual first choice; avoid aspirin and nonselective NSAIDs.
Alternatives: any alternative, including a selective COX-2 inhibitor or rarely an opioid, requires an individualized medical plan.
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Invasive care requires a personalized hematology plan. Deep blocks and vascular lingual or floor-of-mouth injections require preoperative systemic hemostatic measures; lower-risk infiltration or intraligamentary routes still need individualized assessment.
Invasive care requires a personalized hematology plan. Deep blocks and vascular lingual or floor-of-mouth injections require preoperative systemic hemostatic measures; lower-risk infiltration or intraligamentary routes still need individualized assessment.