Child Dental Patient with Hereditary clotting disorders - HAEMOPHILIA

Clinical cases

Clinical case 1


Alex, age 16y

Main dg:

  • Severe type A haemophilia (F VIII = 1%)
  •  B and C hepatitis

 

Dental dg:

  • multiple untreated caries in permanent dentition, some with pulp invovement
  • uncomplicated crown fracture of 21
  • chronic periodontal inflammation due to calculus; gingival bleeding

 

Treatment

  • All procedures with potential bleeding – under protection
  • Non-vital techniques for endodontics where possible
  • Amalgam restorations were preferred to composites (for better long-term resistance)

 

Problems encountered:

  • Longer treatment sessions in order to reduce need for repeated F VIII administration
  • Poor understanding of the importance of regular check-ups: Patient does not show for follow-up; Time gap: 14 years

 

 

Reason for seeking treatment:
Poor appearance of upper front teeth (brown discoloration);
gingival bleeding with brushing, especially when using toothpaste with bleaching effect in attempt to deal with the appearance issue

Clinical findings:
cervical caries of upper front teeth
non-complicated occlusal caries in lateral teeth (15, 16, 17, 37, 46)
occlusal caries with pulp involvement in 36,28

 

Panoramic X-ray after a first treatment session:

occlusal restorations (15, 16, 17, 37, 46) and a temporary filling on 36 were placed without F VIII protection

 

Treatment

► Cervical composite restorations on upper front teeth

► Endodontics on 36 (non-vital technique) with subsequent placement of a crown; preparation was done avoiding gingival bleeding

► extraction of 28

► IMPORTANT:

  • manoeuvers susceptible to induce bleeding were scheduled in longer sessions after administration of F VIII, with maximum of clinical manoeuvers per session
  • treatment sessions were organized as to need the minimum number of F VIII administrations (2)

 

 

Clinical case 2


S.A., age 14 y

Main dg:

  • mild form A hemophilia

      (F VIII = 40%)

Dental dg:

  • multiple caries without pulp involvement
  • calculus; gingivitis

 

 

 

Clinical aspects at first visit

 

16 - Dg:  non-symptomatic deep caries (palatal-occlusal surfaces)

Treatment:

Careful partial removal of carious dentin and provision of an IRM restoration

Rationale:

 

  • avoid bleeding
  • avoid pulp exposure
  • increase chances for dentin formation and thichening of pulp chamber walls - avoid need for endodontics  

Note: F VIII administration not needed

 

Clinical case 3


Edi, age 7 y

General dg
 mild form A hemophilia

 

Reason for visit
first dental check-up

 

Dental dg

  •  mixed dentition
  •  a tendency to front cross-bite (21/31)
  •  mild gingivitis (poor hygiene motivated by bleeding while brushing)

 

 

Treatment:

early interception of cross-bite by composite splint, thus avoiding more complex orthodontics for a later stage

Problems encountered:


Patient did not show for regular check-ups after removal of splint