Dental procedures may lead to bleeding in VWD, hemophilia

People with von Willebrand disease (VWD) or hemophilia may experience bleeding complications after dental procedures, a new study highlights.

Bleeding after such procedures, notably tooth extractions, was particularly common when patients weren’t taking their medications as directed, or were otherwise not following recommendations for post-procedure care, the researchers noted.

The small study involved 26 people with bleeding disorders in Brazil who had a tooth extracted at an outpatient clinic, “following the protocols of the Brazilian Ministry of Health,” per the researchers.

According to the team, “the prevalence of post-surgical complications identified in the study was 26.07%, with 15.38% of cases presenting bleeding after extraction.”

These data highlight the need for good oral hygiene — and emphasize the importance of clear communication between patients and healthcare providers to improve clinical outcomes after dental procedures, the scientists noted.

Titled “Oral post-surgical complications in patients with hemophilia and von Willebrand disease,” the study was published in the journal Hematology, Transfusion and Cell Therapy.

Study assessed the prevalence of dental procedure complications

VWD and hemophilia are both disorders in which the blood cannot clot properly, leading to easy and prolonged bleeding. Bleeding disorders like VWD and hemophilia can lead to abnormal bleeding and other complications during surgeries and dental procedures.

Now, a team of scientists from the Arthur de Siqueira Cavalcanti State Institute of Hematology sought to assess the prevalence of postsurgical complications associated with dental procedures in people with bleeding disorders. To that end, the team examined the outcomes of slightly more than two dozen patients who underwent major dental procedures at their clinic.

Among the patients, 12 had VWD, 10 had hemophilia A, and four had hemophilia B.

All of the individuals undergoing procedures reported brushing their teeth at least twice daily. Most, but not all, reported daily flossing and tongue brushing.

To manage bleeding associated with surgery, the VWD patients were given standard treatments, such as desmopressin and clotting factor concentrates. The hemophilia patients, meanwhile, were treated with standard replacement therapies. Most patients were also given tranexamic acid, an antifibrinolytic agent that prevents clots from breaking down, reducing bleeding.

Researchers stress need for keeping up with dental care

Among all of the patients, six experienced complications after the dental procedure. Hemorrhage, or extreme bleeding, occurred in two VWD patients and two people with severe hemophilia. (Inflammation in the region where the tooth was removed, known as alveolitis, occurred in one patient with VWD and another with hemophilia.

The researchers noted that three of the patients who experienced post-procedure complications had not followed guidelines given by their clinicians. Two of the patients experiencing hemorrhage had not been taking tranexamic acid as directed, and one individual who developed alveolitis had been smoking after the procedure.

These findings emphasize the importance of making sure that protocols are clearly communicated to patients and that reminders are given as often as needed, the team noted.

“It is the healthcare professional’s responsibility to communicate care guidelines effectively to reduce the risk of forgetfulness and associated complications,” the researchers wrote, adding that it’s important for healthcare providers “to tailor instructions to the understanding of patients to minimize complications and improve postoperative quality of life.”

Good oral hygiene is crucial for patients with blood disorders. … Regular dental visits, at least every six months, are recommended for monitoring and prevention.

The scientists also highlighted that, when all medications were taken as directed, bleeding complications were relatively rare overall.

“With this knowledge, dental surgeons can feel more confident about performing surgery on patients with blood [disorders],” the team wrote.

The findings also underscore the need for patients to practice good dental care.

“Good oral hygiene is crucial for patients with blood disorders. … Regular dental visits, at least every six months, are recommended for monitoring and prevention,” the researchers wrote.