(TC53) Endodontic Treatment on Patients with Inherited Bleeding Disorders

Inherited bleeding disorders add complexity to invasive dental treatment. The World Federation of Hemophilia guidelines indicate that no preoperative haemostatic cover is needed when performing endodontic treatment, but the prospect of intra-pulpal bleeding and need for regional local anaesthetic block injections can cause anxiety for dentists and patients alike, especially in individuals with severe bleeding disorders such as severe haemophilia, type III von Willebrand’s disease, Glanzmann’s thrombasthenia or Bernard-Soulier syndrome. In these situations, patients may require hemostatic cover prior to treatment, resulting in a finite time window for treatment. The significant costs of these products, which support haemostasis, necessitates good planning and efficient treatment protocols to minimize the number of visits. Repeated exposure to these products can lead to inhibitor and antibody formation, which in turn leads to even more complicated and costly medical management. Equally, consideration needs to be given to the strategic importance of teeth in order to prioritize treatment over extraction, which carries a more significant bleeding risk. The table clinic will look at the medical considerations, pre-operative planning, and the clinical considerations during treatment with case studies of patients with Bernard-Soulier, Glanzmann’s thrombasthenia, and severe hemophilia who have undergone endodontic treatment. Practical tips and techniques to use when injecting local anaesthetic, positioning rubber dam clamps, managing gingival or intra-pulpal bleeding, and maintaining apical control to avoid apical trauma will be discussed. Strategies to promote haemostasis with a variety of local or pharmacological measures will be discussed to help practitioners undertake endodontic treatment safely for these patients.