This section of Next Step provides parents, caregivers, children, and teens 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

Children and teens may be so busy with school, sports, and social activities that they don't find time to brush and floss. Or if they brush, they may not be doing it correctly. Children and teens also tend to eat a lot of sugary foods that can lead to cavities. It’s helpful for parents, caregivers, children, and teens to discuss the importance of good oral and dental health habits. Children and teens should go for regular dental appointments and cleanings to prevent problems.

Brushing and Flossing

Brushing and flossing are the best ways to keep teeth and gums healthy. They help prevent cavities and gum disease, like gingivitis. 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, and do not share toothbrushes to prevent the spread of germs and bacteria.

Flossing should begin as soon as two teeth touch each other. If your child has a joint problem, 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 Hemophilia Treatment Center (HTC) or dental provider.

In addition to daily brushing and flossing, here are some other tips to keep teeth and gums healthy:

  • Limit sugary or starchy foods, especially sticky snacks. Sugar helps plaque grow which irritates gums. 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 major health problems, tobacco stains teeth and gums and causes bad breath. Chewing tobacco and cigarettes increases the 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.
Braces

Children and teens with bleeding disorders can wear braces just like everyone else. In most cases, getting braces does not cause bleeding. Talk with your child's orthodontist about the procedure beforehand. You can also talk with your Hemophilia Treatment Center (HTC) to determine what kind of pretreatment might be needed. The orthodontist can take special measures to avoid cutting or irritating the gums when bands and wires are placed on the teeth.

Your child should conduct a daily finger check to inspect their mouth for wires sticking out and poking the gums. Ask the orthodontist to show your child or teen how to apply dental wax to the brace bracket. The brace bracket is the small piece of metal, ceramic, or plastic attached to the tooth. Using dental wax can reduce cutting and irritation of the cheeks, tongue, and gums.

Dental Care and Bleeding Disorders

Good oral and dental health begins with regular oral and dental care. 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 with your dental provider. 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 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.
  • 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.

Guarding Against Mouth Injuries

Mouth bleeds are common in children and teens 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 children and teens 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 hot foods that can burn the tongue or the inside of the mouth
  • Avoid some hard foods like pretzels and crusty bread that can cause cuts in the mouth if your child experienced mouth bleeds in the past.
  • Never run with anything in the mouth to avoid choking and hurting the cheeks, teeth, gums, or lips.

If your child or teen plays sports, they should wear a mouth guard. Mouth guards cover the upper teeth and can help protect against broken teeth, cut lips, and mouth injuries. It's especially important to wear a mouth guard if your child wears braces.

If your child or teen has a mouth or tooth injury, contact your Hemophilia Treatment Center (HTC). For more information about types of bleeds, please go to Identifying Different Types of Bleeds.