This section of Step Up provides parents, caregivers, teens, and young adults with information on oral and dental care. This information includes an overview of good oral and dental health habits, information about how to prevent mouth injuries, 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
Dental Care and Bleeding Disorders
Guarding Against Mouth Injuries
The Goal of Good Oral and Dental Care
The goal of good oral and dental care is to keep gums and teeth healthy. 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 the 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, brush your teeth and floss regularly. Healthy gums do not generally bleed, even in a person with a bleeding disorder. You may see some bleeding if you brush 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, contact your Hemophilia Treatment Center (HTC) or dental provider.
A regular brushing and flossing routine can help prevent gum disease, maintain a healthy smile, and protect teeth for a lifetime!
Brushing and flossing are the best ways to keep teeth and gums healthy. They help prevent cavities and gum disease, like gingivitis, which can make gums red, sore, and bleed. 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. Remember to replace toothbrushes every three months.
Gums may bleed slightly when you first start flossing or if you have not flossed in a while. 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 Hemophilia Treatment Center (HTC) or dental provider.
Here are some extra steps you can take for oral and dental health:
- Limit sugary or starchy foods, especially sticky snacks. Sugar helps plaque grow which can irritate gums and lead to more bleeding. Snack on fruits and vegetables and drink water instead of soda. You can also limit the number of times per day you eat sugary foods.
- Don't smoke. Not only does smoking cause health problems, but tobacco also stains your teeth and gums, and can cause bad breath. Chewing tobacco and cigarettes increase your chances of getting gum disease, mouth sores, or other serious health problems.
- Avoid mouth piercings. Mouth and lip piercings can cause problems for a person with a bleeding disorder. They can cause bleeding, infections, cracked teeth, and damaged gums.
- Keep regular dental appointments.
Dental Care and Bleeding Disorders
Good oral and dental health begins with regular dental care. People with bleeding disorders have the same dental issues as everyone else, but complications related to poor dental care are a little more serious, especially if surgery is needed. Be sure to schedule regular checkups and teeth cleanings. The dental provider can identify problems early and help with healthy habits.
It is important to find a dental provider who knows about bleeding disorders and your overall care plan. When you find a dental provider who you are comfortable with, connect them with your Hemophilia Treatment Center (HTC). If you cannot find a dental provider, contact your HTC. Your HTC can recommend a dentist or may have a dental provider as part of their comprehensive care team.
Here are some important facts to remember about dental care for a person with a bleeding disorder:
- Tell your dental provider if you are 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 bleeding disorder
- If you are on prophylaxis, schedule dental visits on days when you receive factor replacement treatment
- Contact your dental provider and HTC if you have prolonged bleeding after a teeth cleaning
- Contact your 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 or other treatment 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
- 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
Wisdom teeth are usually the last adult teeth to arrive in the back of the mouth. Not everyone will have wisdom teeth. People with bleeding disorders may experience prolonged bleeding when the wisdom teeth come in. They might need an antifibrinolytic agent, nasal desmopressin (DDAVP), factor replacement or other treatment.
Talk to your Hemophilia Treatment Center (HTC) or health care provider about a strategy for managing and treating this type of bleed. If there is enough space in the mouth or if the teeth do not come through the gum, there may be no need to remove the teeth. If other teeth aren't in the right place or the mouth is too small for the wisdom teeth to fit, the teeth may become impacted and need to be removed (called extraction). If the teeth become inflamed several times, the teeth may also need to be removed.
The removal of wisdom teeth should be planned out with the oral surgeon and HTC team. Removing wisdom teeth may risk damaging the nerve near the site of the teeth. If teeth need to be removed tranexamic acid used topically may support healing following the procedure. A soft foods diet after tooth removal may also be helpful during the healing process.
Guarding Against Mouth Injuries
Mouth bleeds are common in teens and young adults with bleeding disorders. Accidents, falls, and injuries to the mouth, gums, tongue, cheeks, and lips often cause bleeding. Usually, these bleeds are minor but can look alarming when the blood mixes with a large amount of saliva.
Here are some safety tips for people with a bleeding disorder:
- Always wear mouth guards when playing sports.
- Wear mouth guards and night guards to avoid chipped teeth and cut lips.
- Avoid getting a lip or tongue piercing. Oral piercings can cause health risks in people with bleeding disorders. They can cause bleeding, infection, nerve damage, gum damage, and can crack or chip teeth
- Avoid hot foods that can burn the tongue or the inside of the mouth or crusty foods if you have previously had bleeding in your mouth
- Never run with anything in your mouth—besides choking, you can hurt your cheeks, teeth, gums, or lips
If you have a mouth or dental injury, contact your Hemophilia Treatment Center (HTC).
For more information on types of bleeds, please go to Identifying Different Types of Bleeds.