A Parent’s Guide to Dental Care for Children with Bleeding Disorders
(Hemophilia or von Willebrand Disease)
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A visit from the tooth fairy is an exciting time for a child and can happen anytime or anywhere. You may want to keep a “tooth fairy kit” for your child with the school nurse and have another one handy with you. If bleeding from loss of a baby tooth continues for more than 2 hours, contact your child’s hemophilia team immediately.
Children with hemophilia need to see a pediatric dentist regularly.
A child should have his/ her first dental visit no later than 12 months of age.
You can help prevent cavities by having early and frequent dental check-ups and preventive treatments, such as fluoride and sealants.
Your child’s dentist will work with your child’s hematologist to make sure that your child gets the necessary factor and/ or medications for the dental treatment.
Questions to ask your child’s dentist:
Will my child need factor replacement before dental treatment?
Maybe. The hematologist will decide based on your child’s bleeding disorder and the type of dental treatment needed. Some children may need only DDAVP and/ or Amicar for simple dental fillings. The hematologist may recommend factor replacement if your child needs to have teeth taken out.
Should I brush my child’s teeth even though the gums bleed?
Yes. Brushing is very important to keep a clean mouth and healthy gums. If your child does not brush, plaque will build up along the gum margins and continue to cause bleeding. Always use a soft-bristled toothbrush. You can also dip the toothbrush in hot water to soften the bristles and make brushing easier.
Should I floss my child’s teeth?
Yes. Flossing cleans the plaque between teeth. It is important to use the dental floss in an upward and downward motion, making a C-shape around the tooth. Don’t floss in a sawing motion; it can cause damage to the gums.
Can my child have braces (orthodontic treatment) in the future?
Maybe. Braces can make it more likely to get cavities but if your child has a healthy diet and keeps their teeth and gums healthy, it should be ok to get braces. If possible, the orthodontist will treat your child without taking out any teeth.
Which medicine should I give my child for a toothache?
You can give Tylenol ® to a child with a bleeding disorder. You should not give Motrin® or Aleve® (ibuprofen, naproxen sodium) because they increase the risk for bleeding.
Does my child need prescription fluoride products?
The dentist may prescribe these based on a dental exam and x-rays.
What should I do if a baby tooth is loose?
Don’t worry. A visit from the tooth fairy is an exciting time for children. Here are some things to keep in mind:
Let the tooth fall out by itself. Don’t pull loose baby teeth.
Don’t let your child pick at the spot or irritate the area where the baby tooth was.
Don’t brush the spot where the baby tooth was for a couple of days. Make sure to keep brushing the rest of your child’s mouth.
Don’t let your child use mouthwash, or even swish with water; this can remove the clot that is forming.
Give your child soft foods that can be mashed with a fork for a couple of days.
Have your child bite down on moist tea bag if there is bleeding. If that does not work, have your child bite on gauze moist with Amicar®.
Be prepared! A visit from the tooth fairy can happen anytime or anywhere: at school, on the playground, or even during a vacation. You may want to keep a “tooth fairy kit” for your child with you and another one with the school nurse. Your “tooth fairy kit” should contain gauze, Amicar®, a tea bag, and any emergency phone numbers.
Contact your child’s hemophilia team immediately if bleeding from loss of a baby tooth continues for more than 2 hours.
Questions you should ask your child’s pediatrician:
Does my child need any extra protection while receiving dental care?
Is there anything the dentist should do differently for my child?
Does my child need a transfusions or factor replacement before dental treatment?
How can I prevent cavities and gum disease in my child?
Brush your child’s teeth every morning and night with a soft toothbrush.
Use toothpaste with fluoride in it and the ADA seal of approval on the tube.
Floss after brushing at night. Flossing cleans between the teeth where the bristles of a toothbrush cannot reach.
Drink fluoridated water.
Stay away from foods that have added sugar. In-between meal snacks should not be sweet treats.
Do not drink juices, sodas, or sports drinks often.
Questions your child’s dentist might ask you:
Who are the doctors your child sees and how can I get in touch with them?
Who is your child’s nurse coordinator from the hematology team? How can I contact the nurse coordinator?
Does your child need scheduled factor replacement or only as needed?
What medicines does your child take? What are the dosages? How does your child take the medicine (liquid, pills, or injections)?
Do you have standing prescriptions for Amicar® and/ or DDAVP®?
Does your child have any drug and food allergies?
Has your child ever needed to go to the emergency room from a bleeding problem?
What does your child eat for meals and snacks, and what do they drink?
Has your child had any complications or problems when having dental work done in the past?
Is your child afraid of the dentist?
When should my child see a dentist?
A child should see a dentist within 6 months of the first tooth coming in or by the first birthday- which ever happens first. Remember, it is never too late to start taking your child to the dentist.
How often should my child see the dentist?
Most children should see the dentist every 6 months. However, if your child is at high risk for cavities, the dentist may want to see your child every 3 or 4 months.
How to find a pediatric dentist:
American Academy of Pediatric Dentistry: www.aapd.org
American Board of Pediatric Dentistry: www.abpd.org
Additional Information on Bleeding Disorders:
Note: The information you see describes general oral health information for children with bleeding disorders, but it does not apply to everyone. This information is not medical advice. Please contact a healthcare provider if your child has a medical problem. If you think your child may have a medical emergency, please call your child’s doctor or an emergency number immediately.
Text by Priyanshi Ritwik, DDS, MS
Edited by Julie Schiavo, MLIS, AHIP