This section of  First Step provides parents, caregivers, and children with information on oral and dental care. This information includes an overview of good oral and dental health habits, information about the first teeth a child receives, and dental treatment for people with blood or bleeding disorders.

This section of Dental Care will cover:

The Goal of Good Oral and Dental Care

Brush Up on the Basics of Oral and Dental Care

Baby Teeth to Permanent Teeth

Dental Care and Bleeding Disorders

The Goal of Good Oral and Dental Care

It's never too early to start good oral and dental health practices. Even newborns should have their mouths and gums gently cleaned with a soft gauze pad after every feeding. The goal of good oral health and dental care is to keep both the teeth and the gums healthy and clean. The gums (called gingiva) are soft tissue and cover the bones surrounding the roots of the teeth. One of the early stages of gum disease (called periodontal disease) is gingivitis. Gingivitis is a swelling of the gums caused by bacteria. One of the first signs of gum disease is spontaneous bleeding.

Gum disease is a much more difficult problem for people with bleeding disorders because gums will bleed longer. Treating the bleed with medicine or other treatment may temporarily stop the bleeding but not the underlying gum disease. To prevent gum disease, start routine oral and dental health habits early. Teach your child to brush their teeth and floss regularly. Parents and caregivers need to brush their child’s teeth after their child brushes until the child is 7 years old.

Healthy gums do not generally bleed, even in a person with a bleeding disorder. You may see some bleeding if your child brushes too hard. Do not stop the brushing or flossing routine if light bleeding occurs. If bleeding lasts longer than 20 minutes or stops and starts again, talk with your child’s Hemophilia Treatment Center (HTC) team or health care provider.

A regular brushing and flossing routine can help prevent gum disease, maintain a healthy smile, and protect teeth for a lifetime.

Brush Up on the Basics of Oral and Dental Care

Brushing and flossing are the best ways to keep teeth and gums healthy. They help prevent cavities and gum disease. To make brushing and flossing more fun, have plenty of oral hygiene supplies ready, such as soft toothbrushes, colored or flavored floss (or plastic flossers), and good-tasting toothpaste with fluoride.

For children under three years, use a rice grain size amount of toothpaste. For children older than three years, use a pea size amount of toothpaste. As your child becomes an independent brusher, you may need to check that they are doing a good job with these tasks. Remember to replace toothbrushes every three months and tell your child not to share toothbrushes to prevent the spread of germs and bacteria.

Flossing should begin as soon as two teeth touch each other. In the beginning, you will have to floss for your child. As your child’s coordination improves, you can help them learn to floss. To stress the importance of flossing, floss for them regularly until they are 7 years old. If your child has a joint problem in their arm, such as an elbow bleed, you may need to help them.

Gums may bleed slightly when your child first begins flossing. Plaque is the sticky film of bacteria that forms on teeth and gums. When plaque is removed, the gums will be healthier, and bleeding will lessen. Usually, this initial gum bleeding doesn't require factor replacement or other treatment. However, if bleeding continues for more than 20 minutes or stops and then starts again, call your child’s Hemophilia Treatment Center (HTC) or dental provider.

Here are some extra steps you can take for good oral and dental health:

  • Limit sugary foods and drinks
  • Keep regular dental appointments
  • Talk with your dental provider about fluoride treatments
  • Start preventive dental care when baby teeth begin to come in
  • Don't pull on loose baby teeth
  • Don't let your child run with anything in their mouth
  • Start positive messaging about oral and dental health early to address any fear and anxiety about oral and dental care

Finding a Dental Provider

For a child with a bleeding disorder, it's important to find a dentist who knows about bleeding disorders and your child's overall care plan. Finding a dentist for your child should happen no later than 12 months of age.

When you find a dentist who you and your child are comfortable with, connect them with your child’s Hemophilia Treatment Center (HTC). If you cannot find a primary dentist, contact your HTC. Your HTC can recommend a dentist, or one may be part of their comprehensive care team.

Baby Teeth to Permanent Teeth

The first tooth to come in for your child and the first baby tooth to come out are times to celebrate. Keeping a few precautions in mind, this can be true for a child with a bleeding disorder as well. When a baby's first tooth comes in and when it falls out isn't the same for every child.

Here is a timetable for these milestones:

  • 4 to 7 months: the first teeth (called primary teeth) appear (called eruption)
  • 5 to 6 years: the first tooth is lost (called exfoliation); this can happen as young as 4 years of age or as old as 8 years of age
  • 6 to 8 years: the permanent teeth start to come in
  • 17 years: wisdom teeth start to come in

As every parent or caregiver of a teething baby will tell you, incoming teeth can cause discomfort. This doesn't stop with baby teeth. Incoming permanent teeth can also cause aches, pain, and soreness.

Here are some tips to help lessen your child's discomfort when new teeth come in:

  • Tell your child to chew food on the other side of their mouth
  • Give your child soft foods to eat for several days
  • Tell your child not to brush over a new tooth that's bleeding
  • A cold but not frozen teething toy or washcloth can also sooth a child’s gums

If your child has a loose tooth, encourage them to not wiggle the tooth with their fingers or tongue. Trying to remove a loose tooth before it’s ready to come out can irritate the gums and cause bleeding. Removing a loose tooth too soon can also injure the tooth socket, or the hole where the tooth used to sit. It's best to let baby teeth fall out naturally, without pulling, so less bleeding will occur. Some bleeding is common when a tooth comes out. Bleeding can usually be controlled with simple steps.

Here are some tips to manage bleeding when a child loses a tooth:

  • Keep direct finger-and-gauze pressure for several minutes
  • Have your child bite down on a rolled-up piece of cotton or moist tea bag as the tannic acid in the tea narrows blood vessels to help form a clot
  • Don't let your child rinse their mouth
  • Give your child soft, cool foods. Avoid hot foods for a couple of days
  • If the bleeding goes on for longer than two hours, call your child’s Hemophilia Treatment Center (HTC) or health care provider

You may need to give your child their bleeding disorder medication, such as factor replacement products or other treatment. The dental provider may instruct you to use a prescription medication to help preserve the blood clot once it forms.

If you have any concerns about oozing or bleeding as a new tooth comes in, talk with your child’s Hemophilia Treatment Center (HTC).

Dental Care and Bleeding Disorders

People with bleeding disorders have the same dental issues as everyone else, but complications related to poor oral and dental care are a little more serious, especially if surgery is needed. Be sure to schedule regular checkups and teeth cleanings for your child. The dental provider can identify problems early and help with healthy habits.

Here are some important facts to remember about dental care for a person with a bleeding disorder:

  • Tell your dental provider if your child is on prophylactic therapy and how you treat any bleeding episodes. Prophylaxis is a treatment regimen to prevent bleeds.
  • Tell your dental provider about any changes in the treatment of your child's bleeding disorder.
  • If your child is on prophylaxis, schedule dental visits on days when your child receives factor replacement treatment.
  • Contact your child’s dental provider and HTC if your child has prolonged bleeding after a teeth cleaning.

Treatment for Dental Procedures

  • Contact your child’s Hemophilia Treatment Center (HTC) or health care provider before any dental procedures. The HTC, dental provider, and oral surgeon can develop a pretreatment plan. Having a pretreatment plan before a dental procedure reduces the risk of prolonged bleeding after the procedure. They will work together to:
    • Decide what bleeding disorder medicine might be needed based on the bleeding disorder and the type of dental procedures planned
    • Treat any mouth infections with antibiotics before doing any surgical procedure
  • If your child has a port, they may also need to take antibiotics prior to dental procedures
  • Bleeding may be controlled with special procedures and rinses
  • If pain medication is needed, do not use any medicine like aspirin that increases bleeding
  • Ask your dental provider or HTC team about a special diet after dental procedures, such as a tooth removal, to reduce bleeding
  • Follow all steps outlined by the HTC, dental provider, and oral surgeon before any dental procedure