Trauma and Surgical Treatment

If a patient presents with oral bleeding from trauma a fall or injury, initial management by the dental provider should include assessing the location, type, and severity of the bleed. If seen in the dental office, and upon completion of the initial assessment, the dental provider should contact the hematologist/HTC immediately to inform them of the patient’s dental emergency, status, and obtain guidance on treatment. In the case of dental trauma, it’s critical to remember that as a dental provider, we are part of the comprehensive hemophilia care team and that treatment planning for emergency required input from the whole team to reduce the risk of further problems.⁵⁴

Surgical procedures, including dental extractions, alveoplasty, and implant placement, are all possible for patients with bleeding disorders, as long as guidelines are followed. Typically, for surgical procedures, factor replacement aims to achieve at least 50% of normal factor level. Atraumatic techniques, including the use of periotomes, extractors, long-lasting resorbable sutures such as glycolide and L-lactide, and stents are essential tools for success.

Stents, as shown in Figure 7 are hard acrylic, inexpensive, and easy to fabricate custom-made trays that can be used with or without other hemostatic measures. They are useful in cases of dental extractions, especially for patients with inhibitors, during implant placement, and after scaling and root planing or other periodontal procedures.