Oral Health plays a role on Oral Fibrinolytic Activity

Background: In spite of the high incidence of gingivitis and periodontal disease in the hemophiliac population, few are known about the influence of oral health condition as risk factor for bleeding after dental extraction in this patient population. The aim of this report is to use a group of patients under oral anticoagulation as a model of acquired bleeding disorder to show the importance of local fibrinolytic activity in the oral cavity, and propose, based on these data, a safe approach for dental extraction and other dental procedures in hemophilia patients. Patients and methods: Twelve patients were submitted to twenty dental extractions. Previous studies have demonstrated the role of the periodontal microbiota in binding and fibrinogen degradation, which might have a role on oral fibrinlysis. Oral health was measured using Gingival Index and Plaque Index which are based on recording the level of gingival inflammation due the presence of soft debris and/or mineralized deposits on the indexed teeth, respectively. Samples of non-stimulated saliva were collected before and after extraction. Samples of peripheral blood and alveolar blood were collected for fibrinolytic activity analysis, using the Fibrin Plate Method. The results showed a higher fibrinolytic activity on the alveolar blood samples when compared with the peripheral blood (p=0.006) samples. This activity also showed a positive correlation with the oral health indexes (Gingival Index and Plaque Index p<0.05). Salivary fibrinolytic activity showed a significant increase after the tooth extraction. Oral fibrinolytic activity was increased after tooth extraction and it was not related to oral health indexes. Conclusion: The fibrinolytic activity presented on the site of extraction was correlated with the level of gingival inflammation demonstrated by the oral health index of the extracted tooth. The fibrinolytic activity in the surgical site can represent a risk factor for secondary or late bleeding after dental extraction in patient with inherited bleeding disorder.