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Penny McCarthy is Haemophilia Clinical Nurse Consultant, Ronald Sawers Haemophilia Centre, Alfred Health, Melbourne
Gum bleeding in the absence of trauma or injury in adults with haemophilia is often reported. This can be distressing for the patient and often leads to days off work.
In managing your haemophilia it is important to use simple preventative health measures such as brushing your teeth to maintain good oral hygiene as this will prevent gum bleeding.
Without good oral hygiene gum bleeding will occur with or without haemophilia.
It is important to remember haemophilia does not cause gum bleeding.
In the absence of trauma or injury, gum bleeding is usually caused by plaque build-up. Plaque is a sticky bacterial film found on teeth. The bacteria found in plaque changes sugars into acids which then causes tooth decay.
The plaque can build up on the gum line and cause the gums to become inflamed. Inflamed gums bleed easily. The plaque if left untreated may destroy the gingival fibres that hold the teeth in place leading to periodontal disease and eventually loss of teeth.
No matter how much factor is administered, if the plaque is not removed, the bleeding will continue.
The best way to remove plaque is regular (twice a day) brushing with a fluoride tooth paste and using dental floss between the teeth plus regular trips to the dentist for professional cleaning. Rinsing will not remove plaque.
Fluoridated drinking water and toothpastes have reduced the amount of dental decay in Australia. However, remember bottled water usually does not contain fluoride! So, save your money and, if you can, drink water from the tap.
In 2010 the Australian Haemophilia Centre Directors’ Organisation (ACDHO) wrote a consensus statement on the dental treatment of patients with inherited bleeding disorders. Their view is:
With children routine normal or assisted exfoliation of primary teeth does not require
haemostatic cover. Persistent oozing and bleeding following the procedure should initially be managed with local measures, such as pressure and 5% tranexamic acid solution.
What this means is, a person with a bleeding disorder needs to visit their local dentist for routine care. If there is bleeding following the visit to the dentist this is best managed using tranexamic mouthwash.
Tranexamic mouthwash and tablets are relatively inexpensive compared to the very costly factor concentrate, but more importantly it is more effective at stopping gum bleeding.
So next time you have bleeding gums, before you treat with factor, call your Haemophilia Treatment Centre. Try tranexamic acid and visit your dentist!
Australian Haemophilia Centre Directors’ Organisation. A consensus statement on the dental treatment of patients with inherited bleeding disorders. Melbourne: AHCDO, 2010. www.ahcdo.org.au
Better Health Channel > Dental care - www.betterhealth.vic.gov.au
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