Oral health care considerations for patients with bleeding disorders
Hemophilia A and B
von Willenbrand Disease
Oral health care considerations for patients with bleeding disorders:
- >50,000 cells/mm³ – Routine dental procedures, including simple extractions.
- 20,000-50,000 cells/mm³ – Platelet transfusions may be indicated for surgical procedures.
- <20,000 cells/mm³ – No elective dental care.
Hemophilia A and B:
- 50%-100% of factors for surgical procedures.
- >50% of factors for routine dental care.
- >30% of factors for mandibular blocks.
- For mild cases, use DDAVP.
- AAOS/ADA 2003 guidelines for joint replacement prophylaxis suggest covering patients with hemophilia with antibiotics prior to dental procedures. The AAOS/ADA 2013 guidelines do not have this provision. Instead clinicians are encouraged to use their clinical judgement.
- Factor replacement is calculated based on severity of disease and patient’s weight.
Hemophilia A – 1 unit of factor VIII (F VIII)/kilogram of body weight raises the F VIII level by 2%
(Example – A 70 kg person with hemophilia A needs 3,500 unit to raise a factor level from <1 to 100.)
Hemophilia B – 1 unit of factor IX (F IX)/kilogram of body weight raises the F VIII level by 1%.
(Example – A 70 kg person with hemophilia B needs 7,000 unit to raise a factor level from <1 to 100.)
von Willenbrand Disease:
Consider desmopressin acetate(DDAVP) for surgical procedures.