Guidelines for Dental Treatment of Patients with Inherited Bleeding ...

Guidelines for Dental Treatment of Patients with Inherited Bleeding Disorders 7conjunction with metronidazole. Erythromycinmay be effective in people with penicillinallergies, but it may not be suitable for moresevere infections [34].Clindamycin produces high alveolarconcentrations [35], and bactericidal activity isreached with the usual recommended oral doseof 150 mg every 6 hours. In more severe cases itcan be given intravenously. It has been reportedthat clindamycin can cause antibiotic-associatedcolitis and therefore is often reserved for thetreatment of the more serious infections or whenpenicillin has failed [33,34].Periodontal infectionPeriodontal pockets host a variety of differentbacteria, the majority of them being anaerobic.Regular oral hygiene prevents these bacteriafrom causing gingival inflammation.In patients with severe gingival inflammation, inparticular those who are immune compromised,the use of an antimicrobial agent may beindicated. Metronidazole is considered the drugof choice due to its action against anaerobicorganisms. It may be used in conjunction witheither penicillin or erythromycin. However,antimicrobial therapy is no substitute for oralhygiene treatment.Topical treatmentThe most common forms of topical treatmentinvolve the use of an antibacterial mouthwash.These have value as an adjunct to hygiene phasetreatment. The most common treatments are:• Chlorhexidine gluconate: Chlorhexidine isavailable as a mouthwash, spray, andtoothgel. It is most commonly used as atwice a day mouthwash with the patientrinsing their mouth with the solution for 30–60 seconds. The toothgel may be used inaddition to the mouthwash. chlorhexidinehas a tendency to stain teeth so the length ofeach course of treatment should be limited.• Povidine-iodine: povidine-iodine isavailable as a mouthwash and can be usedfor the treatment of acute periodontalproblems. In addition, it may be useful toirrigate the periodontal pockets. It must beused with caution during pregnancy.Dental emergenciesDental emergencies can occur at any time;however, it is important to remember that notreatment should be carried out without priorplanning as this could result in additionalproblems.The most common dental problems are pain dueto caries and bleeding from the periodontaltissues. Pain related to caries can usually betreated with either antibiotics or pulpectomy inorder to allow time for the planning of theextraction. Bleeding from the periodontal tissuescan usually be controlled with antibiotics until anappointment with a hygienist can be arranged.The management of dental trauma is morecomplex as it usually involves both the gingivaand the teeth. Local measures will usually controlgingival bleeding and temporary splinting can beused for fractured or loose teeth.With dental trauma, it is important to rememberthat we are part of the comprehensivehemophilia care team treating these patients.Treatment planning for an emergency requiresinput from the whole team to reduce the risk offurther problems.ConclusionThe monograph has been written to helphealthcare workers develop local guidelines forthe management of patients with inheritedbleeding disorders. They should be studied inconjunction with the two previously publishedWFH monographs Primary Dental Care of Patientswith Hemophilia [18] and Oral Care for People withHemophilia or a Hereditary Bleeding Tendency [36].We should like to thank the members of thedental committee for their help and support inthe development of these guidelines and hopethat they help hemophilia healthcare workersthroughout the world improve dental care fortheir patients.