Management Tools

Developing a pathway of care for patients with bleeding disorders should be completed prior to any treatment by the dental team. Following the initial comprehensive examination, the treatment plan should be shared with the patient’s hematologist to determine the proper sequencing of treatment including factor coverage along with developing an emergency protocol.

Figures 8 and 9 demonstrates a two-step management tool designed by West Virginia University School of Medicine, the West Virginia Chapter of the National Bleeding Disorders Foundation, and the West Virginia Oral Health Coalition, titled Bleeding Disorder Procedure Management Plan for Dental Treatment. The management tool helps to coordinate care between the patient, members of the dental team, and hematologist from the beginning to end of the treatment plan.

Figure 8 Information for the Dentist informs the dentist that the patient has a bleeding disorder or is a carrier with increased bleeding potential. The various sections of the form detail in-office procedures requiring factor coverage including restorative care, oral and periodontal surgery, orthodontics, and in some cases routine prophylaxis and diagnostic films. Once a treatment plan is determined, a member of the dental team will contact the patient’s HTC or hematologist, using the contact information on page one, to communicate the proposed treatment plan.

After the treatment plan is shared, the hematology team will create a Bleeding Disorder Procedure Management Plan (Figure 9) which outlines the steps for a safe procedure. The plan is then shared with the patient and the dental office. In addition to implementing a management plan, the following best practices are recommended to further provide the most safe and effective care for the patient.

• For current hematology/HTC patients, plan to schedule dental appointments at least 2-4 weeks in advance to ensure the patient has enough time to obtain medications (i.e. factor) needed to infuse before and after dental procedures.

• Patients who do not have a hematologist may require longer times for establishing care, establishing the correct bleeding disorder diagnosis, and obtaining medications to enable successful treatment.

• Plan procedures earlier in the week in case a complication arises that will need to be managed by the HTC or hematologist