Dental Treatment in Hæmophilia

EXCESSIVE bleeding following minor trauma is the heritage of the haemophilic, consequently extraction of a tooth presents a formidable problem. During the recent survey of hamophilia carried out in Northern Ireland many of the patients had severe dental caries or septic roots resulting from simple neglect of elementary dental hygiene. The haemophilic is usually reluctant to have dental treatment and can only be persuaded to visit a dentist when suffering from severe toothache. It is not perhaps fully appreciated by both hemophilics and doctors that conservative dental measures such as fillings and scalings may be carried out with safety. Also in the hamophilic the natural exfoliation of deciduous teeth is not associated with hxmorrhage of any severity. Furthermore, the presence of infection in relationship to a permanent tooth may result in such a fibrotic reaction that should the tooth subsequentlv exfoliate or require to be removed the area of haemorrhage is considerably reduced. A scheme for dental inspection and treatment has been inaugurated at this centre, in an attempt to educate hamophilic patients in the principles of dental hygiene, and so to delay extraction for as long as possible. If it is considered essential to have dental extractions carried out, the patient is admitted to hospital, where he can be kept under observation and where serious bleeding can be dealt with without delay. For this operation the patient then becomes the responsibility of both the doctor and the dentist, working as a team. The decision to extract teeth in a hamophilic should only be taken when the fullest conservative measures have failed. Also the indications for extractions must be carefully considered and the danger of extraction weighed against the retention of the septic roots which may exfoliate naturally. In this centre, during the past three years, thirty-six teeth have been extracted from a total of eleven patients suffering from classical haemophilia. Four of these patients were severely affected, four were moderately affected, and three had only mild symptoms of the disease. The haemophilic was admitted to hospital on the day prior to extraction and a definite plan was followed. The more important aspects of this will now be discussed.