The Power of Your Choice
Your choice of the IHTC Pharmacy Program directly supports your IHTC team and patient services, and activities provided to the hemophilia community. The IHTC Pharmacy Program provides savings to you and your health insurance plan.
Every patient has the right to choose their clotting factor pharmacy provider. The IHTC supports your right of choice and will assist you in making an informed decision.
Bleeding Disorder Dental Care
Important Dental Care Information for Parents of Children with Bleeding Disorders
Good dental hygiene is important for all children, including those with bleeding disorders. However, you need to take some special precautions when preparing your child for dental procedures. You also need to give essential information to the dental care provider to make sure that you get the best results with the procedure as well as your child’s long-term dental health.
Planning for Dental Procedures
It is very important for your child’s dentist to work with the nearest comprehensive hemophilia treatment center (HTC) to develop treatment plans for dental procedures. This will ensure that the procedures are performed safely. Some dental procedures need special considerations, depending on the severity of your child’s bleeding disorder.
To prepare for certain dental procedures, factor replacement, Stimate® (desmopressin acetate) nasal spray or Amicar® (aminocaproic acid) may be needed. Such procedures include block anesthesia, deep scaling, extractions, large fillings and any oral surgery. You must contact your HTC before any dental procedure to find out what pre-treatment may be required.
Amicar® or aminocaproic acid is an important medication for anyone with a bleeding disorder, and is only available by prescription. Amicar works by preventing enzymes in the saliva from breaking down a newly formed clot. The medication allows the tissue under the clot to heal and prevents re-bleeding.
The safety and effectiveness of Amicar in children has not been established; however, Amicar is generally well tolerated. Amicar, like most medications, may cause side effects or an allergic reaction in some children. Before giving Amicar, be sure to call your HTC to confirm the dose and course of therapy. Amicar comes in tablet or syrup form. The dosage depends on the weight of the child. If your child has any reaction after taking Amicar, you should immediately contact your doctor. Please note that Amicar should not be used if you child has any of the following medical issues: a urinary tract infection, blood in the urine, or a kidney problem.
Amicar should be stored at room temperature and protected from heat, light, and moisture. Amicar may also be stored in the refrigerator, which helps improve its taste. Over time, Amicar loses its strength. As with all medications, be sure to check the expiration date.
Young children with bleeding disorders tend to have more bleeding when teeth are falling out or new teeth are coming in. Oozing can often be controlled by applying firm yet gentle pressure to the affected area using a small amount of Avitene® (microfibrillar collagen hemostat). Avitene is a shredded gauze-like substance designed to control soft tissue bleeding, especially when conventional methods to control bleeding are ineffective. Condense a small amount of Avitene and apply it to the bleeding site. Avitene can be used along with Amicar.
Informing Your Dentist
To provide the best dental care for your child, your dentist needs to have answers to the following questions:
- What is the type and severity of your child’s bleeding disorder?
- Does he/she have an inhibitor or venous access device?
- What medications does your child take?
- Is pre-dental treatment with factor concentrate, Stimate, or Amicar required?
- Whom should we contact at your HTC?
Your comprehensive HTC will give you instructions about treatment of bleeding disorders. The HTC will have the necessary patient data on hand to help your dentist provide the best dental care for your child.
Preventing and Treating Mouth Bleeding
Although tooth decay is unfortunately common among children, the main dental issue for children is injury. Injuries to the mouth, tongue, teeth, gums, cheeks, and lips are common childhood experiences.
- People with bleeding disorders are discouraged from taking part in high contact sports such as football, soccer, boxing, and wrestling. For those children who may take part in high contact sports, a proven dental protection measure is mouthguards.
- When bleeding in the mouth does occur, it is often difficult to determine its severity. A small amount of blood mixed with saliva seen on a pillow or bed sheet can be alarming. Because some types of bleeding from the mouth are dangerous, it is appropriate to contact your HTC when your child experiences a mouth bleed. Before calling the center, try to find out the source of the mouth bleed so the HTC dental hygienist, nurse, or physician can provide the best treatment advice.
- The mouth’s naturally moist environment makes it difficult for clots to form. Therefore, to stop the bleeding you may need to treat with factor concentrate or Stimate nasal spray. Amicar is frequently given to maintain the clot and promote healing.
- Bleeding in the mouth should be treated by applying firm but gentle pressure to the bleeding site using a clean gauze, a washcloth, or a moist tea bag. Tannic acid in tea leaves cause blood vessels to constrict. Gently holding an ice pack against the child’s face or having him/her eat a Popsicle can stop the oozing.
- If a “liver clot” has developed (an injured area in the mouth with a liver-like texture and appearance), it should be removed so that proper healing can occur. This can usually be done using a moist gauze square. After the liver clot is removed apply gentle pressure and Avitene. If the bleeding continues, give the child Amicar and call your HTC. If the liver clot cannot be completely removed, your child should be seen by his/her dentist or your HTC to have it removed. Once the liver clot is removed, the patient should begin taking Amicar.
A mouth injury can take as long as two weeks to heal completely. To help the healing, your child should eat soft foods that are either cold or at room temperature. To keep the teeth clean during the healing process, either brush gently or use a cotton swab. During healing, don’t let your child use straws to drink from or rinse the mouth too vigorously— either of these activities may dislodge the clot.
A word of caution: Some mouth bleeding can block a child’s airway. The following symptoms should be considered medical emergencies:
- Nonstop bleeding of the tongue, cheek, or floor of the mouth;
- Bruising or swelling of the tongue, throat, or neck; and/or
- Difficulty breathing or swallowing.
Should any of these symptoms occur, contact your local HTC and take your child to the emergency department.
Saving a Knocked-Out Tooth
If your child has a knocked-out tooth, be careful to pick it up by the crown or top part of the tooth. Try not to touch the roots. Then, ideally, place the knocked-out tooth in milk. If milk is not available, use water to keep the tooth moist. Get to your dentist or an emergency department as soon as possible. There is a chance that your dentist may be able to successfully reinsert the tooth. Until you reach your dentist, be sure to apply firm pressure with a clean gauze square or washcloth to the bleeding site. Also, contact your HTC for recommendations to control the bleeding.
Fixing a Chipped Tooth
If your child chips a tooth, try to find the chipped fragment and take it to your dentist. The dentist may be able to bond the chipped piece back onto the damaged tooth. The dentist also may repair the chipped area with a filling material and file any sharp edges that could cut your child’s cheek or tongue.
Children with bleeding disorders are able to wear braces. If your child needs braces, your dentist will refer you to an orthodontist. This dental specialist will fit your child with removable or fixed braces. However, before beginning orthodontic treatment, it is highly recommended that you review the treatment plan with your comprehensive HTC. Inform the orthodontist about your child’s bleeding disorder, so that he or she can be especially careful to avoid irritating or cutting the gums when the orthodontic appliance – bands and wires – is placed on the teeth. Please note that in most cases, the placement of braces does not cause bleeding. As an additional preventive measure, the orthodontist can show you how to apply dental wax to the appliance wires to protect gum tissue.
Following Post-Treatment Instructions
Once any dental work is completed, your dentist and the HTC will provide you detailed instructions to follow throughout the mouth healing process. Ice may be suggested to reduce any mouth swelling. After a tooth extraction, your child should avoid using straws, eating hot foods, and mouth rinsing for several days. It is important to complete the Amicar treatment prescribed by your hematologist. Stopping the use of Amicar too early can cause bleeding to re-occur. Your dentist can recommend a non-aspirin pain reliever if necessary. (Please note that when Amicar is prescribed, the recommended dosage course of 5-7 days should be completed.)
Special Precautions for Special Cases
If your child has a venous access device or heart murmur, be sure to discuss the need for prophylactic antibiotic therapy before certain dental procedures. The IHTC follows the American Heart Association recommendations regarding the use of amoxicillin:
- Adults: 2 grams 1 hour before dental treatment
- Children: 50 mg/1 kg 1 hour before dental treatment
- For penicillin allergy, take clindamycin:
- Adult: 600 mg 1 hour before dental treatment
- Children: 20 mg/kg 1 hour before dental treatment
- If your child has an inhibitor, every dental procedure must be discussed in advance with your HTC.
Contact the IHTC
Always consider your HTC as a partner in your child’s complete healthcare needs, including dental healthcare. Call the IHTC at 317- 871-0000 (toll free: 877-256-8837) and ask to speak to a dental hygienist.