Treating Dental Patients With Bleeding Disorders

October 2007, Submitted to the Journal of the Georgia Dental Association

By Cathy Hulbert, LCSW, and Rueleen Lavergne, RN, Hemophilia of Georgia Outreach Staff

Dentists play a crucial role in the overall good health of all patients, and in particular those with hemophilia and other bleeding disorders such as von Willebrand Disease or Platelet Function Disorders. People who have bleeding disorders often require infusions of clotting factor or other medications to control bleeding.

In treating patients with bleeding disorders, it is important for dentists to know that they have an important ally in linking with hematologists at the state's hemophilia treatment centers in Atlanta at Emory Healthcare and Children's Healthcare of Atlanta, in Augusta at the Medical College of Georgia, and in Savannah at Backus Children's Hospital. Hemophilia of Georgia, a nonprofit organization, is a trusted resource for medical providers and a crucial link between hematologist and dentists in the development of patient-specific treatment plans that detail the medications required to prevent bleeding.

During annual visits to a Hemophilia Treatment Center, people who have bleeding disorders are encouraged to see their dentists regularly for routine cleanings and exams which usually do not require pre-treatment with clotting factor. And they are reminded not to wait if they or their hematologists suspect dental problems such a gum disease.

"Working hand-in-hand with HoG to get a treatment plan is the biggest step toward making this a smooth process," said Dr. Michael Pruett, director of the General Practice Residency Program at the Medical College of Georgia School of Dentistry. "With the proper treatment plan, these patients are really no different from any other patients or from you and I. The biggest point that I have for dentists is that a little knowledge about how to handle their care, and the use of Hemophilia of Georgia as a resource, goes a long, long way to avoiding complications."

People who have bleeding disorders are taught from an early age to understand the importance of taking good care of their teeth and gums to prevent the need for invasive procedures which would require pre-treatment with expensive medication as well as longer recovery periods. This message was reinforced during Hemophilia of Georgia's Camp Wannaklot this summer. More than 150 children and teens who have bleeding disorders learned about everyday heroes in their communities, including dentists. Each day, a group of little "tooth fairies" made up cheers about the importance of good dental care and performed for the rest of the campers.

In addition to educating patients and helping dentists contact the appropriate hematologists for bleeding disorder treatment plans, Hemophilia of Georgia provides comprehensive community services that can give doctors and nurses added peace of mind: outreach nurses and social workers make regular follow-up calls and home visits to bleeding disorder clients and they are frequently in the field doing in-services at emergency rooms and the offices of dentists, pediatricians and general practitioners. In-services also are done at schools and day care centers. For physicians and other medical providers, HoG publishes Protocols for the Treatment of Hemophilia and von Willebrand Disease and provides a 24-hour physician-to-physician hotline for Georgia physicians who need emergency treatment information.

HoG can also work with dentists who are treating the uninsured, often providing financial assistance to pay for all or a portion of their bills, depending on income. In fact, HoG was founded 34 years ago so that people in Georgia affected by bleeding disorders live as normally and productively as possible.

The HoG staff is available to answer questions and provide additional information. Please call 770-518-8272 or email mail@hog.org. We look forward to hearing from you!

Additional Information About Bleeding Disorders

• Hemophilia is a hereditary blood clothing disorder which affects males almost exclusively. It results in a deficiency of clotting factor in the blood. It affects people of all races, nationalities and economic levels.
• Contrary to popular belief, people with hemophilia do not bleed to death from minor external wounds.
• The major problem for people with hemophilia and other inherited bleeding disorders is bleeding inside the body, especially bleeding into joints such as the knees, elbows and ankles.
• Current treatment for hemophilia is clotting factor, which is genetically engineered. It is infused into the veins to stop bleeding episodes. More serious bleeding episodes require repeated infusions.
• Von Willebrand Disease (VWD) is an autosomal dominant disorder affecting males and females equally. According to the CDC, approximately 1-2% of the U.S. population is affected by von Willebrand Disease. Von Willebrand Factor is a clotting protein produced in cells that line blood vessels and are slowly released into the blood stream. VWD is caused by a defect or a deficiency of von Willebrand Factor.
• Most types of VWD can be treated with a synthetic hormone called Desmopressin Acetate (DDAVP), either by IV or Stimate nasal spray. In some cases DDAVP does not work. In these cases, a hematologist may recommend a clotting factor concentrate.
• Patients affected by storage pool or Platelet Function Disorders have a normal amount of platelets, but they are abnormal in size or shape, or do not function properly.