Dental leaflet for patients with haemophilia

1
Dental leaflet for patients with haemophilia

• Evelyn Lawless RDN, Dental Nurse
• Carol Edmonds RDN, Dental Nurse
• Karen Dineen, RDN Dental Nurse
• Carmel Egan Clinical Nurse Specialist Coagulation

2
(No Transcript)
3
National Centre for Hereditary Coagulation
Disorders (NCHCD)

• Comprehensive national centre for the treatment
  of adults with coagulation disorders in Ireland.
• Extensive multi-disciplinary team
• Consultant-led dental team - 3 sessions per week
• SCD Post-Grad, student nurses hygienists
  from Dublin Dental Hospital

4
Dental service

• 2 on-site dental surgeries
• Full range of restorative, surgical, preventive
  care
• IV sedation for phobic and anxious patients
• Max Fax input once per month

5
The Dental Liason Nurse

• Co-ordination and administration of clotting
  factors for patients attending the dental clinic
• Support and advice for patients
• Medical Education of Dental Personnel
• Dental Education of Nursing/Medical staff
• Development of new guidelines, policies and
  procedures in relation to service

6
New treatment protocol

• 2006 new WFH guidelines on dental treatment of
  patients with inherited bleeding disorders.
• 2005 Lee et al - effectiveness of Tranexamic
  Acid mouthwash for dental scaling in pts with
  haemophilia
• Proposal to the Coagulation Team to implement new
  dental protocol at the Dublin Haemophilia Centre
• Only pts with severe or moderate haemophilia
  needed to receive continuing dental care at the
  centre
• Pts with mild disease discharged to General
  Practice for continuing or shared care

7
Discharge Policy

• All patients being discharged from the centre
  given final dental appointment and advice.
• Newly diagnosed or adolescents transfered from
  childerens hospital assessed by medical/dental
  team categorised according to whether need shared
  care or continuing dental care at centre.
• A follow up letter including diagnosis,
  guidelines and contact details for the centre
  posted to the patient to give to the GDP
• Telephone contact assured for support and queries
  from patients and dentists

8
Development of leaflet
Haemophilia and Dental Care

• Fiske et al. Exressed needs of Patients with
  Haemophilia JDOH 2000
• Audited - House Officer
• Dental attendance query at yearly coagulation
  review appt.
• Development of supporting information leaflet by
  dental nurses

Prepared by K. Dineen, C Edmonds, E. Lawless
with the Irish Society of Haemophilia
9
Taking Your Oral Health Seriously

It is important for people with bleeding
disorders to take good care of their teeth and
gums. Making regular visits to the dentist will
reduce the chances of future problems like
extractions or infections which can lead to
further complications Sometimes dental care
falls to the bottom of a very busy list of things
to do. However, when you have been diagnosed with
a bleeding disorder such as Haemophilia or Von
Willebrands Disease, taking care of your teeth
needs to be given high priority. Attending the
Dentist If you have mild or haemophilia (30 or
greater) it is fine to attend your own dentist
for routine care such as check ups, filllings,
scale and polish and other things like root
canal, crowns and cosmetic work. You should
inform your dentist about your bleeding disorder
and advise him/her that further information is
available from your haemophilia treatment centre.
However, should you need a tooth extraction,
some deeper injections, gum surgery or a dental
implant or then your dentist should contact your
haemophilia consultant or nurse for advice as
this type of treatment will usually need to be
provided in a specialist centre. The contact
details are on the back of this leaflet Your
dentist will chat with you about how often you
need to attend for check ups and give you
information how to prevent dental problems.
Everyone with haemophilia should attend their
dentist at least once a year
10
F.A.Q
Can I use my local dentist? Being able to visit
a local dentist is very important as it allows
you a get full range of care in a convenient
location. In most cases, once your dentist has
more details and guidance about your bleeding
disorder from your haemophilia centre they are
more than happy to safely carry out routine
dental care. Information on the back of this
leaflet will advise your dentist how to make
contact with your haemophilia team who are all
very experienced and knowledgeable about dental
treatment for persons with a bleeding disorder
and they will give your dentist the necessary
assurances.
11
F.A.Q
Should I brush my teeth if my gums bleed? Gums
that bleed regularly after tooth brushing are a
sign of early gum disease which is very common,
but it is important that this does not progress
to more severe gum problems. The recognised
treatment is to visit your dentist or hygienist
for advice and to get the teeth professionally
cleaned and monitored. Your dentist might advise
for you to use a medicated mouthwash and will
recommend methods for brushing and cleaning your
teeth more effectively. Your bleeding disorder
may mean that your gums bleed a little more
easily and for a little longer until the gums
heal but it is important during this time to
continue toothbrushing with a soft brush to
remove the plaque and food debris which causes
the gum disease.
12
F.A.Q
What Happens if I need a tooth extraction? This
should always be co-ordinated by your haemophilia
centre so that it can be carried out safely with
some special precautions to prevent bleeding
afterwards. Depending on the severity of your
bleeding disorder your haemophilia team may
choose to give you factor replacement therapy
and/or tablets before the tooth is extracted and
a special mouthwash afterwards. In addition the
dentist may stitch the wound and use a special
surgical packing to stop any bleeding. This
method has been used very successfully for many
years to overcome the problems previously
associated with extracting teeth and has been
recommended by the World Federation of
Haemophilia (WFH)
13
Information for Dentists
It is recommended that you liase with the
patients haemophilia team for advice regarding
the severity of your patients bleeding disorder
before undertaking any treatment for the first
time. Patients with moderate or severe
haemophilia (less rthan 5 clotting factor)
should usually be seen in a specialist setting.
However, patients with mild Haemophilia and Von
Willebrands Disease can safely receive most of
their dental care in general dental practice. It
is essential that a rigorous preventive regime is
followed to minimise the need for future surgery
or development of periodontal problems. General
Tips Comprehensive up to date guidelines for
treating patients with mild haemophilia can be
found at www.wfh.org Fillings, scaling, root
canal and all cosmetic and preventive care can be
carried out routinely on patients with mild
disease, however care should be taken with the
soft tissues, especially the use of impression
trays, aspirators and x-ray films in the floor of
the mouth and retromolar region. Areas of
Concern Extractions and surgery, gingival
surgery/deep root planing and implant placement
all pose a bleeding risk even in patients with
mild haemophilia so it is essential that these
procedures are carried out with the necessary
pre-operative special measures such as factor
replacement, DDAVP or Cyclokapron Tablets,
suturing and packing. Please refer your patient
with a dental treatment plan and suitable
radiograph to your nearest haemophilia centre, if
such procedures are required, when the on-site
dental team will arrange and carry out the
treatment if required. Local Anaesthetic and
Analgesia Infiltration injections pose no risk to
patients with haemophilia. Inferior Dental Blocks
(ID Blocks) however, potentially could cause a
muscle bleed which might compromise the airway,
so should be avoided where possible in patients
with less than 30 factor levels. Alternative
techniques should first be considered in order
to anaesthetise posterior molar teeth such as
buccal infiltration with articaine or
intraligamentory anaethesia. If an ID Block is
unavoidable, patients with less than 30 factor
levels will require factor replacement prior to
administration. Take care when recommending pain
relief, NSAIDs and Aspirin are likely to
aggrevate a bleeding condition so paracetamol or
codeine based products are more appropriate.
14
www.wfh.org
GUIDELINES FOR DENTAL TREATMENT OF PATIENTS
WITH INHERITED BLEEDING DISORDERS Andrew
Brewer Oral Maxillofacial Surgery Department
The Royal Infirmary, Glasgow, Scotland Maria
Elvira Correa Centro de Hematologia e
Hemoterapia da Unicamp Sao Paulo, Brazil On
behalf of World Federation of Hemophilia Dental
Committee
15
Haemophilia and Dental Care
16
(No Transcript)
17
www.haemophilia.ie
18
Thank - you
19
REFERENCES

• Brewer A, Correa M.E. (2006) Guidelines for
  Dental Treatment of Patients with Inherited
  Bleeding Disorders.
  World Federation of
  Haemophilia Monograph no. 40.
• Fiske J. Ford H, Savidge G, Smith M. (2000) The
  expressed dental needs of patients attending a
  Haemophilia Reference Centre.
  Journal of Disability and Oral Heath 20
  (5).
• Lee A, Boyle C, Savidge G, Fiske J. (2005)
  Effectiveness in controlling haemorrhage after
  dental scaling in people with haemophilia by
  using tranexamic acid mouthwash.
  
  British Dental Journal 19833-38.
• Dougall A ,Fiske J. (2008) Special Care
  Dentistry-Safety.
  British Dental Journal 204 (15)