Dental Treatment

During dental treatment procedures, it is critical for all members of the dental team to be vigilant in preventing accidental damage to the oral mucosa. All providers can assist in avoiding accidental injury by:

• Careful placement and use of saliva ejectors.

• Careful placement and removal of impressions

• Careful placement of x-ray films, especially in the sublingual region

• Protecting soft tissues during restorative treatment by using a rubber dam or applying liquid barriers such as Vaseline.³⁷

Additional recommendations include the use of nonmetallic trays during impression procedures to avoid soft tissue trauma and covering the suction tip with gauze to help reduce trauma to the oral mucosa.^38,39 Individuals with a bleeding disorder may have central venous access, also known as a CVAD or a port for their prophylaxis factor infusions. In addition, some patients may present with a shunt from a previous injury, like intracranial bleeding. In general, and in agreement with the American Dental Association guidelines, antibiotic prophylaxis is not routinely needed for patients with a CVAD or port before dental treatment.⁴⁰ The risk of infection is not greater for patients with bleeding disorders, but the medical complexity of these patients may be greater than the general population. If the patient had infectious complications of vascular access devices in the past, the hematologist could suggest prophylaxis in the bleeding disorder management plan; however, this would not be common. Patients who infuse factor with butterfly needles or a port generally have a very advanced understanding of their venous access. However, some patients may require assistance with infusion, for example from a family member or a hematology-coordinated infusion center. A dental office would not be expected to obtain IV access or assist in factor infusion; this would be coordinated with the hematologist/HTC.