Evaluation of Dental Procedures on Hemophilic Patients in a Comprehensive Program for the Care of Hemophilia (Part 1)

Progress to date on this hemophilia research has been both definite and positive. In the dental treatment of hemophilic patients, emphasis has been given to the pedodontic aspect. It has been shown that with consultation of the patient's physician and using standard operative procedures with precautionary care, hemophiliacs can be treated, and dental health can be achieved in a hemophiliac. A comprehensive program will minimize the necessity for extractions, and the subsequent sequela of tooth migration, periodontal disease, extraction of other teeth, and prosthetic appliances. Conjoined with the medical approach, dental surgery can often avoid or minimize hospitalization.Two fundamental statements summarize the treatment plan for hemophiliacs : a) For hemophiliacs, as for all, there is no substitute for good dental procedures, and dental treatment is not elective but mandatory; b) Current knowledge of procedures and techniques for the prevention and treatment of the hemophiliacs' dental ills no longer justifies the dentists' hesitation in treating them.The hemophiliac has the usual dental problems found in the general population. His dental morphology and anatomy are clinically the same as a “normal” patient's, and so may be his dental history, if it is one of neglect ending in acute dental decay or disease because he fears bleeding, pain, possible hospitalization, and loss of time from work or school.Dental treatment for the hemophiliac is most effective as an integral part of a total rehabilitation program because the dental staff then has access to the physician, to the hospital, and to hematological and psychosocial services.We feel that in order to establish safe outpatient care for the hemophiliac, the technique and conservative methods of dental treatment presented in this study need to be joined with the medical and psychological approaches and with patient education and cooperation. Dental procedures, especially extraction, should no longer be considered a life-threatening situation. The development of programs to treat hemophiliacs on either an outpatient or a private basis must be established. The financial burdens, time lost from work or school because of hospitalization, andthe emotional and psychological problems with dental treatment warrant the development of such programs.Observations of hemophilic patients by the investigator showed that a hemophilic patient postpones dental treatment partly because of his own ignorance of the need for dental care ; partly because he fears ignorance on the part of dentists in the matter of treating hemophiliacs ; and partly from discouragement about the prospect of still more loss of his time, continued disabilities, and perhaps hospitalization.To summarize treatment, when the data were tabulated, 572 treatments and restorations were performed on 361 teeth in 107 hemophilic patients ranging in age from three to 57 years. Current work when tabulated will bring the totals to approximately 600 treatments on approximately 117 patients. From the research on these patients, the investigators have established safe restorative and surgical procedures for hemophiliacs.