Hemorrhagic Disorders Affecting The Oral Cavity

Hemorrhagic Disorders Affecting the Oral Cavity

Question. Describe a hemorrhagic disorder affecting the oral cavity.
Answer. The hemorrhagic disorders are described as follows:

Hemophilia A

It is a hereditary disorder of blood coagulation characterized by excessive hemorrhage due to prolonged coagulation time. It is caused due to deficiency of factor VIII or antihemophilic factor.

Males are clinically affected, and females are carriers of the trait.

Hemorrhagic disorders’ oral manifestations

Hemorrhagic Disorder Oral Manifestations

• Traumatic injury of the oral cavity.
• The anatomic sites involved are the frenum of the lip and the tongue
• Prolonged bleeding after tooth extraction.
• Hematoma of the floor of the mouth may occur, and blood may spread via facial spaces and produce hematoma of the larynx, with respiratory embarrassment.
• Physiological processes of tooth eruption and exfoliation are associated with severe and prolonged hemorrhage.

Hemorrhagic Disorder Management

• The main aim is to raise factor VIII levels, which arrest bleeding.
• Replacement therapy: Various forms of replacement therapy are like plasma, cryoprecipitate, and factor VIII concentrates.
• Factor VIII concentrates: The dose and duration of administration of factor VIII concentrates are planned, taking into consideration the site and type of bleeding.
• Intraligamentary injection in hemophilia does not cause hemorrhage, even if replacement therapy has not been given before injection.
• To reduce complications caused by cryoprecipitate or plasma, various drugs are used instead of factor VIII products, before dental extraction, e.g., a synthetic analog of 8-D-arginine, and in combination with tranexamic acid and epsilon aminocaproic acid can be given.

Oral purpura and ecchymosis

Christmas Disease or Hemophilia B

It occurs due to a hereditary deficiency of factor IX. It is transmitted as an X-linked recessive trait through chromosome.

Dental Management of Hemophilia A and Hemophilia B

• Anesthesia: It is given as intrapulpal, periodontal, and papillary injections. Sedation with diazepam or nitrous oxide analgesia can be given.
• Endodontic therapy: During endodontic therapy, care is taken not to extend beyond the apex of the tooth. Hemorrhage into the canal can be controlled by 1:1000 aqueous epinephrine on an endodontic paper point.
• Restorative: It can be carried out in the hemophilic patient, but the rubber dam must be used to prevent trauma to the gingiva and other soft tissues. If a rubber dam is not used epinephrine epinephrine-impregnated hemostatic cord is placed in the gingival sulcus before preparation of crown or inlay margins.
• Prosthodontic therapy: Complete dentures are well tolerated in hemophilic patients. Partial dentures are also well tolerated, as long as patients maintain oral hygiene, because the clasp can trap food debris, resulting in gingivitis and subsequent hemorrhage.
• Periodontal therapy: Conservative periodontal therapy is more desirable.
• Oral surgical procedure: Local hemostatic agents and techniques include pressure surgical pack, oxidized cellulose saturated with bovine thrombin solution, vasoconstrictors, sutures, topical thrombin, and the use of absorbable hemostatic after packing the tooth socket is prevented by a mechanical splint to prevent disturbance to the clot. Postoperative use of anti-fibrinolytic agents and adherence to a soft diet are further advocated to support clot maintenance.
• Aspirin and other NSAIDs
• s are avoided in patients with bleeding disorders owing to inhibiting their platelet function, and IM injection is not given due to the risk of hematoma formation.
• Electrosurgery is not recommended because it causes tissue necrosis.

Factor V Deficiency or Parahaemophilia

It is a rare hemorrhagic disorder caused by a deficiency of factor V.

Oral Manifestations of Hemorrhagic Disorder

Spontaneous gingival bleeding occurs. Prolonged bleeding after the extraction of a tooth.

Management of hemorrhagic disorder

Transfusion and freshly frozen plasma is given when there is excessive hemorrhage.

Disseminated Intravascular Coagulation

It is an acquired bleeding disorder that is generally acute but may be chronic in onset in certain instances.

The acute DIC is clinically severe with depletion of multiple clotting factors, such as fibrinogen, prothrombin, factor V, factor VIII, and platelets are reduced in numbers.

Hereditary Hemorrhagic Telangiectasia

It is transmitted as an autosomal dominant trait and is characterized by bleeding from mucous membranes and telangiectatic lesions in skin and mucosa.

Hemorrhagic Disorder Oral Manifestations

• The oral cavity, lips, and tongue are commonly affected.
• It appears as cherry red, often slightly raised, pinpoint or slightly large lesions resembling a crushed spider.
• Severe oral hemorrhage may be experienced several times a day or for weeks.
• Hemorrhage can be encountered during dental treatment that encroaches on the affected area.

Hemorrhagic Disorder Management

• A sclerosing agent such as sodium corrugate or sodium tetradecyl sulfate injected into the lesion is useful.
• Electrocautery is also useful, prophylactically, in a lesion that is likely to bleed.