Title: Inclusion health in action: Delivering dental care for patients with bleeding disorders in a specialist clinic
Abstract:
Background: Patients with inherited bleeding disorders face challenges in accessing dental care due to increased bleeding risk. The bleeding disorders clinic operates under a service level agreement between the Birmingham Community Healthcare Special Care Dentistry (BCHC SCD) team and Queen Elizabeth Hospital (QEH). This case series highlights the complexity of dental management within this cohort.
Case 1: A 68-year-old male was seen by the clinic. Medically, the patient has severe chronic refractory immune thrombocytopenia (ITP) with suspected intracranial haemorrhage. Dentally, the patient presented with generalised periodontitis, attrition into dentine posteriorly, and asymptomatic periapical pathology of the lower left first permanent molar (LL6). Alongside the haematology team, a treatment plan was developed. This included periodontal disease treatment and restoration of the worn teeth. Bleeding was managed with pre- and post-operative tranexamic acid (TXA) and local haemostatic measures. Definitive treatment of LL6 was delayed pending investigation of the suspected intracranial bleed.
Case 2: A 90-year-old female was seen by the clinic. Medically, the patient has type 2 von Willebrand’s disease and requires ambulance transport. Dentally, the patient presented with generalised periodontitis and a grossly carious lower left second molar (LL7) with acute apical periodontitis. Alongside the haematology team, a treatment plan was developed, including extraction of the LL7. Bleeding was managed with pre-operative desmopressin, local haemostatic measures and post-operative TXA orally.
Case 3: A family of four siblings aged 20–36 years were reviewed. Medically, the brothers have severe haemophilia A, and the sister is a low-level carrier due to their mother being a carrier. The brothers self-administer prophylactic factor replacement and take TXA as required. The sister, although a carrier, requires intravenous desmopressin or factor VIII cover for invasive dental procedures.
Conclusion: These cases highlight the importance of multidisciplinary planning to deliver safe, inclusive dental care for patients with bleeding disorders.
