Görkem SENGEZ, Can DÖRTER, Ezgi ERDEN KAYALIDERE

Hemofilik Hastalarda Çürük Kontrolü ve Tedavisi

Hemofili hastalarının bir çoğunda diş çürüğü ve periodontal hastalık insidansı sağlıklı kişilere göre daha yüksek görülmektedir.Bunun nedeni, bu hastaların ağız içi kanama korkusu nedeni ile etkili bir ağız hijyeni sağlayamamalarıdır. Etkili bir ağız hijyenisağlanmadığında diş etinde kanama görülme olasılığı artar, bu sebeple hemofilik hastalarda düzenli diş fırçalama, ağız bakımı vediş hekimi kontrolleri oldukça önemlidir. Diş hekimleri bu hastaların tedavisi sırasında hastayı takip eden hematolog ile iletişimhalinde olmalıdır. Hastaya gereken ağız hijyeni rutini anlatılmalı, hasta düzenli olarak kontrollere çağırılmalıdır. Bu sayede dişçürükleri erken fark edilerek kanal tedavisi veya diş çekimi gibi daha girişimsel işlemlere gerek kalmadan tedavi edilebilir. Birçokaraştırmacı hemorajiden kaçınmak için restorasyon işlemleri sırasında lokal anestezi kullanılmamasını önermektedir. Ayrıca inhibitörve antikor gelişme riski bulunduğu ve pahalı bir işlem olduğu için faktör replasman tedavisi gerekliliğini en aza indirgeyecek şekildebir tedavi planı düzenlenmelidir. Bu derlemenin amacı hem diş hekimlerini hemofili hastalarına yaklaşım konusunda bilgilendirmek,hem de tıp hekimlerine bu hastaların tedavisinde ağız sağlığının önemini anımsatmaktır.

Caries Management in Hemophilic Patients

Prevelance of dental caries and periodontal diseases may be higher in hemophilic patients than others. Primary reason of this fact isnot providing aqeuate oral hygiene in fear of hemorrhage. However the possibility of bleeding increases with the neglect of oralhygiene. Thus, regular tooth brushing and dental check-ups are important for hemophilic patients. Dentists must be in contact withthe patient’s haematologist. Patient must be given the necessary oral hygiene motivation and appointed for regular check-ups. Bythis means dental caries can be noticed early and treated without the need for more invasive procedures like root canal treatment orextraction. Many researchers suggest not to use local anesthesia during restorative treatment in order to avoid any hemorrhage.Treatment plan must be carried out with the minimum need of factor replacement therapy to avoid the risk of development ofantibody and inhitibitors. The aim of this review is to inform dentists about the dental approach of hemophilic patients and remindmedical doctors about the importance of oral health in these patients.

PDF

___

1. Patton LL. Bleeding and clotting disorders. In: Greenberg MS, Glick M, Decker BC, editors. Burket's Oral Medicine: Diagnosis and Treatment. 10th ed. Hamilton, ON: BC Decker; 2003. pp. 454–77. https://doi.org/10.1093/ortho/30.4.346
2. Gupta A, Epstein JB, Cabay RJ. Bleeding disorders of importance in dental care and related patient management. J Can Dent Assoc. 2007;73:77-83.
3. Jovandaric MZ, Jesic MM. Prenatally diagnosed hemophilia in a newborn: A case report. Fetal and Pediatr Pathol. 2015;34:248-251. DOI: 10.3109/15513815.2015.1051250
4. Castaman G, Eckhardt C, van Velzen A, Linari S, Fijnvandraat K. Emerging issues in diagnosis, biology, and inhibitor risk in mild hemophilia A. In Seminars in thrombosis and hemostasis. Thieme Medical Publishers. 2016;42:507-512. DOI: 10.1055/s-0036-1571309
5. Mannucci PM, Tuddenham EG. The hemophilias— from royal genes to gene therapy. N Engl J Med. 2001;344:1773-9. DOI: 10.1056/NEJM200106073442307
6. Bowen DJ. Haemophilia A and haemophilia B: Molecular insights. Mol Pathol. 2002;55:127–44.
7. Rogaev EI, Grigorenko AP, Faskhutdinova G, Kittler EL, Moliaka YK. Genotype analysis identifies the cause of the “royal disease”. Science. 2009; 326:817-. DOI: 10.1126/science.1180660
8. Brown DL. Congenital bleeding disorders. Curr Probl Pediatr Adolesc Health Care. 2005;2:38-62. DOI: 10.1016/j.cppeds.2004.12.001
9. Sans-Sabrafen J, Besses C, Vivens JL. Hematología clínica. Madrid: Ediciones Harcourt SL; 2001. p.640-74.
10. Bolton-Maggs PH, Pasi KJ. Haemophilias a and b. The lancet. 2003;361:1801-9. DOI: 10.1016/S0140-6736(03)13405-8
11. Dougall A, Fiske J. Access to special care dentistry, part 5. Safety. Br Dent J. 2008;205:177. DOI: 10.1038/sj.bdj.2008.693
12. Gómez-Moreno G, Cutando-Soriano A, Arana C, Scully C. Hereditary blood coagulation disorders: management and dental treatment. J Dent Res. 2005;84:978-85. DOI: 10.1177/154405910508401102
13. Little JW, Falace DA, Miller C, Rhodus NL. Tratamiento odontológico del paciente bajo tratamiento médico. Madrid; Harcourt SL: 2001. p. 466-92.
14. Kasper CK, Lin JC. Prevalence of sporadic and familial haemophilia. Haemophilia. 2007;13:90–92. DOI:10.1111/j.1365-2516.2006.01397.x
15. Schardt-Sacco D. Update on coagulopathies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90:559-63. DOI:10.1067/moe.2000.110437
16. Federici AB. Clinical diagnosis of von Willebrand disease. Haemophilia. 2004;10:169-76. DOI:10.1111/j.1365-2516.2004.00991.x
17. Mannucci PM. Treatment of von Willebrand's disease. N Engl J Med. 2004;351:683-94. DOI:10.1056/NEJMra040403
18. Sonbol H, Pelargidou M, Lucas VS, Gelbier MJ, Mason C, Roberts GJ. Dental health indices and caries‐related microflora in children with severe haemophilia. Haemophilia. 2001;7:468-74. https://doi.org/10.1046/j.1365-2516.2001.00536.x
19. Zaliuniene R, Peciuliene V, Brukiene V, Aleksejuniene J. Hemophilia and oral health. Stomatologija. 2014;16:127-31.
20. Hewson ID, Daly J, Hallett KB, Liberali SA, Scott CL, Spaile G, Widmer R, Winters J. Consensus statement by hospital based dentists providing dental treatment for patients with inherited bleeding disorders. Aust Dent J. 2011;56:221-6. https://doi.org/10.1111/j.1834-7819.2011.01328.x
21. Scully C, Dios PD, Giangrande P. Oral care for people with hemophilia or a hereditary bleeding tendency. Treatment of Hemophilia. World Federation of Hemophilia. Canada. 2008:1(27).
22. Anderson JA, Brewer A, Creagh D, Hook S, Mainwaring J, McKernan A, Yee TT, Yeung CA. Guidance on the dental management of patients with haemophilia and congenital bleeding disorders. Br Dent J. 2013;215:497. DOI:10.1038/sj.bdj.2013.1097
23. Brewer A, Correa ME. Guidelines for dental treatment of patients with inherited bleeding disorders. Haemophilia. 2005;11:504-9.
24. Fiske J, McGeoch RJ, Savidge GF, Smith MP. The treatment needs of adults with inherited bleeding disorders. J Disabil Oral Health. 2002;3:59-61.
25. Meechan JG, Greenwood M. General medicine and surgery for dental practitioners Part 9: haematology and patients with bleeding problems. Br Dent J. 2003;195:305. DOI:10.1038/sj.bdj.4810526
26. Kreuz W, Ettingshausen CE. Inhibitors in patients with haemophilia A. Thromb Res. 2014;134:22-26. DOI:10.1016/j.thromres.2013.10.016
27. Rafique S, Fiske J, Palmer G, Daly B. Special care dentistry: part 1. dental management of patients with inherited bleeding disorders. Dent Update. 2013;40:613-28. DOI:10.12968/denu.2013.40.8.613
28. Ambados F, Woodville South SA. Preparing tranexamic acid 4.8% mouthwash. Aust Prescr. 2003;26:75.
29. Sindet‐Pedersen S. Distribution of tranexamic acid to plasma and saliva after oral administration and mouth rinsing: a pharmacokinetic study. J Clin Pharmacol. 1987;27:1005-8. https://doi.org/10.1002/j.1552-4604.1987.tb05605.x
30. Nuvvula S, Gaddam KR, Kamatham R. Efficacy of tranexamic acid mouthwash as an alternative for factor replacement in gingival bleeding during dental scaling in cases of hemophilia: a randomized clinical trial. Contemp Clin Dent. 2014;5:49. DOI: 10.4103/0976-237X.128663
31. Randall C. Surgical management of the primary care dental patient on warfarin. Dent Update. 2005;32:414-26. DOI:10.12968/denu.2005.32.7.414
32. Harrington B. Primary dental care of patients with haemophilia. Haemophilia. 2000;6:7-12.
33. Gomis M, Querol F, Gallach JE, González LM, Aznar JA. Exercise and sport in the treatment of haemophilic patients: a systematic review. Haemophilia. 2009;15: 43-54. https://doi.org/10.1111/j.1365-2516.2008.01867.x
34. Nakagawa Y, Shimada Y, Kinai E, Kawasaki Y, Maruoka Y, Yamamoto K, Oka S. Long‐handle toothbrush for haemophiliacs with severe elbow arthropathy. Haemophilia. 2015;21:481-3. https://doi.org/10.1111/hae.12751
35. Freedman M, Dougall A, White B. An audit of a protocol for the management of patients with hereditary bleeding disorders undergoing dental treatment. J Dsabil Oral Health. 2009;10:151.
36. Brewer AK, Roebuck EM, Donachie M, Hazard A, Gordon K, Fung D, Clarkson J. The dental management of adult patients with haemophilia and other congenital bleeding disorders. Haemophilia. 2003;9:673-7. https://doi.org/10.1046/j.1351-8216.2003.00825.x
37. Kaya GŞ, Ertunç DA, Yapıcı AG. Antikoagülan tedavisi gören hastalarda minör oral cerrahi prosedürler [Minor oral surgical procedures in patients undergoing anticoagulant therapy]. J Dent Fac Ataturk Uni. 2011;4:1-8.
38. Kumar JN, Kumar RA, Varadarajan R, Sharma N. Specialty dentistry for the hemophiliac: Is there a protocol in place?. Indian J Dent Res. 2007;18:48.
39. Saba HI, Tran Jr DQ. Challenges and successes in the treatment of hemophilia: the story of a patient with severe hemophilia A and high-titer inhibitors. J Blood Med. 2012;3:17. DOI: 10.2147/JBM.S30479
40. Pryor JC, Hirsch JA, Hurst RW. Endovascular management of tumors and vascular malformations of the head and neck. In: Hurst RW, Rosenwasser RH, eds. Interventional Radiology. Informa Healthcare, New York, NY, ABD, 2008, 209.