Orthodontic Treatment

Patients with bleeding disorders may receive both fixed and removable orthodontics. The American Academy of Orthodontics recommends the first orthodontic assessment should occur no later than age 7.⁴⁴ Early orthodontia is especially important for individuals with bleeding disorders. Properly aligned teeth are easier to effectively brush and floss, lowering the risk for the patient to develop caries and periodontal disease. Certain bleeding disorders, such as hypermobility spectrum disorders or hereditary disorders of connective tissue, involve collagen disruption, so moving teeth too quickly can be a potential issue.⁴⁵ If possible, providers should consider both a non-extraction approach along with a single-phase treatment. In some cases, invisible aligners are a good option to minimize the risk of the orthodontic wires abrading gingival tissues. Sharp edges or extruded wire that might cause bleeding or accidental damage to the mucosa should be trimmed from hardware and appliances. Orthodontic wax is especially useful in such cases as a protective measure. In addition, providers should consider the use of bonded attachments (instead of bands) on molars to help minimize trauma to the oral mucosa. ⁴⁶

The dental provider should communicate with the patient’s hematologist to get a better sense of each patient’s needs. For example, if extractions are included in the orthodontic treatment plan, this must be coordinated with the patient’s hematologist along with measures such as determining if antibiotic prophylaxis is required prior to the placement of bands.⁴⁷