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

Guidelines for Dental Treatment of Patients withInherited Bleeding DisordersDental Committee, World Federation of HemophiliaForewordThe dental treatment of patients with inheritedbleeding disorders has been widely discussed inthe literature with the aim of developingguidelines for common procedures. Themajority of guidelines recommend the use ofclotting factor replacement therapy beforeinvasive oral surgery and the use of the inferioralveolar nerve block for restorative dentaltreatment. The dose of clotting factor used variesand this may be due to problems relating to boththe availability and cost of factor concentrates indifferent parts of the world.Successful protocols are the result ofcooperation between hematologists and dentists.These protocols suggest the use of factorconcentrate along with the use of localhemostatic techniques, such as suturing, andlocal measures, such as the use of oxidizedcellulose, for example Surgicel ® or fibrin glue inconjunction with post-operatively administeredantifibrinolytic agents where appropriate. Theuse of local techniques has resulted in certainminor oral surgery procedures being done withminimal or no coagulation factor replacement.The purpose of these guidelines is to provide abasis for the development of local protocols forthe dental treatment of patients with inheritedbleeding disorders.IntroductionHemophilia is an X-linked hereditary disorder.Hemophilia A is a deficiency of factor VIII andhemophilia B (Christmas disease) is a deficiencyof factor IX. Hemophilia is considered severewhen plasma activity is