common bleeding disorders, their symptoms, and the effect they bring on the delivery of oral health care

 common bleeding disorders, their symptoms, and the effect they bring on the delivery of oral health care

Abstract

Dental care is an essential part of human health. That is the reason why most oral care providers insist on strict dental hygiene. Poor dental hygiene leads to several complications, such as bleeding disorders. Bleeding disorders have severe adverse effects, and as such, the providers of oral care should be aware of the impacts caused by bleeding disorders, especially on dental patient’s management. Some of the practices occurring in dental practice include initial recognition of bleeding disorders. These may be an indication of the system pathological process. Systemic restoration of dental patients through surgery is best performed by practitioners who are well versed and very informed on matters regarding pathological conditions, complications, and most of the best treatment for such conditions. As such, one can see the essentiality of oral care providers getting well informed about bleeding disorders, their symptoms, impacts, and treatment processes. The purpose of this paper is to review and analyze some of the common bleeding disorders, their symptoms, and the effect they bring on the delivery of oral health care.

Introduction

Oral health care providers need to know the impact brought about by bleeding disorders, especially on the patients they are attending. The Center for Disease Control usually insists on proper evaluation before treatment is administered. Before treating dental patients, proper medical evaluation has to be carried out. Such evaluation is essential especially when an invasive surgical, dental procedure is planned. The evaluation of patients should be carried out in the most precise way. They should be queried about their past dental, medical history, especially any previous bleeding history.  

Many bleeding disorders run within the families. Such disorders include von Willebrand’s disease and hemophilia. This shows that a family history of the patient needs to be taken into consideration. The purpose of querying the patients is for the practitioner to get a medical history of the patient. This medical questioning gives the practitioner a hint on the drug history of the patient. Drug history is essential since some drugs may hinder dental surgeries. Such drugs as an anticoagulant will require a practitioner to consult with the patients’ physician before carrying out any procedure. Additionally, some medications may end up interfering with the body’s hemostasis and prolong the bleeding. Abused drugs such as alcohol, heroin, among others, will as well have adverse effects by causing excessive bleeding and damage to the liver. This may result in alteration in the production of coagulation factors. As such, medical and drug history is very crucial for oral health providers.

There has been an increase in the number of patients with dental conditions. A large number in the United States is seeking dental treatment. In the United States, the demographic shift has been the leading factor. It is estimated that 56% of the American citizens by the year 2050, will be 55 years and above, 25% of the population will be 65 years and above. Reports have indicated that 39% of the people above 65 years of age will be more prone to chronic dental conditions by the year 2050. Close to 60% of the United States population is taking medication of various medical conditions. Reports have indicated an increase in the pharmacologic management of systemic diseases. This shows that in the near future, a considerable amount of American population shall be limited from their daily activities. Dental conditions such as bleeding disorders are among the estimated cause of worry among the American population.

According to the World Health Organization (WHO), the oral disease poses a major threat to many countries. This is because these diseases affect people throughout their lifetime, which causes pain, discomfort, among other adverse effects. They hold that oral diseases and dental conditions pose the same health risk as major noncommunicable diseases. According to a report by the Global Burden of diseases (2017), untreated dental caries and bleeding disorders are among the most common health conditions. The report held that more than 530 million children suffer from oral diseases, estimating that more than 3.5 billion people worldwide are affected by oral diseases such as bleeding disorders. From the report, one can see that dental conditions such as bleeding disorders have much impact. This calls for oral care providers to be aware of the dangers that these conditions pose, especially for the people who are socially disadvantaged.

The socially disadvantaged members of society are mostly affected by oral diseases.  There has been a strong and consistent relationship between socially-disadvantaged individuals and their prevalence of dental health diseases. This association is in existence ranging from childhood and across the aging population, especially in the low and middle-income earners. The world health organization asserts that most of the people affected are from low and middle-income countries. This is because such countries have weak economies; the living standards of individuals are low, which makes it difficult to access medical treatment. Some people, who live among the marginalized part of the globe, have difficulties accessing medical services. This makes them more prone to adversaries, especially those caused by oral diseases. The same report indicated that most of the dental health conditions are largely preventable and can be treated in early stages; that is, if recognized early and the people have easy access to medical attention. Early diagnosis of such conditions depends on the exposure of the people to medical information, especially those regarding oral health. This shows that practitioners of oral caregivers need to be well informed in these conditions so that they can participate in saving a countries economy since these conditions can affect the country’s economy negatively.

WHO Rejoinder

In the year 2019, oral health was included in the political declaration on universal coverage by the WHO. This was eight years later after the United Nations High-Level Meeting on Noncommunicable Disease acknowledged the considerable burden on many countries posed by oral diseases. During this similar period, the member states endorsed regional strategies calling for actions in favor of oral health. These strategies were supported by WHO and were implemented mostly in Africa, South-East Asia, East Mediterranean, and some parts of the Western Pacific. The above-mentioned areas were primary targets of WHO due to their limited access to medical services and medical information. This overly shows the commitment and dedication of WHO in the promotion of quality oral health and offering essential treatment, especially in the countries with financial constraints.

A reduction in the adversities of oral health conditions requires a focus shift. The focus has to be shifted from invasive dental treatment to preventive measures and minor treatment. The WHO has identified several concrete strategies for improving and facilitating quality oral health.  These strategies and policies are majorly focused on low-income countries and the marginalized population worldwide. The marginalized population has a hard time accessing medical attention due to the scarcity of oral health caregivers in the areas they reside in. Among the strategies by the World Health Organization include; cost effective treatment, strengthening primary health care, and wide prevention globally.

These strategies have been set to be implemented through a three-year road map, ranging from 2019 to 2021. It also comprises of a mixture of normative work and practical support to countries with weak economies. The WHO has set the development of a global health report on oral as its top priority, which is meant to provide status information on global oral health. This status report shall act as the foundation for the global oral health action plan by the world health organization. As such, it is evident that oral health is very crucial, and major players in the world have taken the initiative to avert the hazards presented by oral diseases.

Examples of Bleeding Disorders  

Whenever a bleeding disorder is suspected, necessary laboratory tests are conducted. Bleeding disorders can cause secondary acquired diseases. These include jaundice, anemia, among others. Evidence of excessive gingival, hematomas, or petechiae should direct an oral care practitioner into investigating bleeding disorders. The reason as to why meticulous steps need to be taken in such patients is due to the health implications of bleeding disorders. Apart from interfering with the normal health of an individual, they may result in other complications such as hypertension and the hindrance of homeostasis.

Bleeding disorders are classified into the following major categories; coagulation factor deficiency, vascular disorders, fibrinolytic defects, or platelet disorders. Each of the above categories is fully addressed in the table below:

Platelets disorders may be hereditary or gotten due to decreased or limited production of platelets by the body. They may be caused by excessive consumption and altered body functions as well. A common symptom of this disorder is bleeding within the superficial lesions, ecchymosis and gingivae bleeding. Medical practitioners approximate a minimum platelet count of 50,000/uL for a person to qualify for dental surgery. A count less than the minimum count disqualify an individual for such dental management practices. For such a person, a platelet transfusion is carried out 30 minutes before the surgery. For individuals with acquired platelets disorders, systemic steroids are prescribed a week before the surgery. Whenever oozing of blood continues during a surgery, local measures are put in place to ensure stabilization of the patient.

Vascular disorders are not very common. The rare cases of vascular disorders are oftyen associated with mucosa or skin. These diseases can be treated using laser ablation or coagulation. Advanced modified treatments are usually planned whenever vascular lesions have been recognized during examination. In a sense, the medical practitioners are called to be very keen when conducting examinations. They need to be able to identify such lesions and start planning for advanced or modified treatment. On the other hand, fibrinolytic occurs when fibrin ligaments are consumed or disseminated. These are very common defects among individuals with coagulations syndrome or those on medical therapy. Once examinations have been completed, the practitioneers need to follow the set procedures while treating the patient. Among the steps very essential, is the recognition of the disease, which means that oral care has to be followed strictly.

Among the coagulation defects, hemophilia A , hemophilia B and von Willebrands diseases are very prevalent. Hemophilia A is caused by the lack of a clotting factor. It is inherited among family members and is linked as recessive traits in males. Its symptoms include delayed bleeding, increased ecchymosis, epistaxis and hemarthrosis. During surgery for patients with hemophilia A, requires increasing the levels of desmopressin. These helps in maintaining blood clotting and inhibiting excessive bleeding, which can result to casualties. Bleeding disorders have secondary effects among individuals. Such include hemorrhage of central nervous system as well as gastrointestinal bleeding. These are caused as a result of mild bleeding, if not well taken care of. As such, bleeding disorders do not only impair a person’s oral health, but also affects body functioning at large. This calls for interventions from medical practitioners in a bid to avert some of these effects.

Oral Effects

Deficits of platelets may cause petechiae in oral mucosa. They may as well as lead to development of spontaneous gingival bleeding. Such disorders are present alone in the human body, or in conjunction with other diseases such as leukemia. Chronic bleeding may lead to deposition of brown degraded blood products to the teeth. Individuals suffering from hemophilia may tend to have severe and several bleeding instances throughout their life time. The frequency and severity of the bleeding depends on the severity of the hemophilia. Bleeding disorders increases the chances of developing dental carries and periodontal diseases among the patients. The major cause for this is absence of oral hygiene, or the fear of acquiring professional dental care.

Management Care for Dental

Dental management, especially for individuals with bleeding disorders often depends on the severity of the disorders. These disorders impact differently among the individuals. Some are severely affected while others will take time before experiencing the adversaries of the disorders. Nevertheless, dental management practices are very critical for people with bleeding disorders. Among these practices include: control of pain, oral surgery, restorative procedures, prosthodontics procedures, periodontal procedures, orthodic procedures and choice of medication. Each of these dental management practices is discussed in details below;

Pain Control

Anesthetic infiltration is the best solution in cases of nerve blockage. Patients with suffering from coagulopathies anesthetic injections are rarely used. They are only used when an alternative option does not exist. This is because such injections carry along risks of leading to formation of hematoma. The convection requirement for blood clot is required to be within 20%-30% clotting factor levels. Failure to this, there could result gross swelling, discomforting pain which in some cases may lead to death due to asphyxia. Alternative measures to facilitate cloting during dental surgery may include sedation using nitrous oxide. Such drugs as diazepam are used in place of anesthesia.

Oral Surgery  

Critical safety precautions are required when carrying out a dental procedure. Dental surgeries carry the highest risk of excessive bleeding. In that sense, the practitioners and oral health care providers needs to be informed on the impacts of carrying out dental surgery among different patients based on their previous medical history. For patients suffering from hemophilia, these precautions needs to very extensive since such patients run the greatest risk. They require factor infusion, which helps in blood clot and prevent excessive loss of blood. Other substances that can be used include frozen plasma, depending on the conditions exhibited by each patient. Most importantly, the patient’s hematologist has to be consulted before planning any treatment procedure. The hematologists are necessary in providing the essential medical details of the patient.

Necessary caution is required to reduce the rate of bleeding. This is especially required when vasoconstrictors are in usage. Vasoconstrictors increase the risk of excessive bleeding due to the effects of vasodilation. Materials with absorbable hemostatic are highly recommended to ensure stability and formation of a clot. However, they carry a considerable risk of infection and delayed healing. As such, these materials are not to be used in patients with immunosuppressed. Rapid formation of hemostasis of a wound could be facilitated by topical thrombin, as it facilitates faster conversion of fibrinogen into fibrin.

A drug which may pose a threat to bleeding mechanism does not have a significant challenge in cases of dental treatment.  If the patient was under medication and they have to be withdrawn before the surgery, it has to be ten days before. Drugs such as those that are antiplatelet do not need to be stopped prior to a dental surgery. Local measures those that include hemostasis are efficient and sufficient enough to stop and control excessive bleeding. The important aspect of these treatments, include consulting with the patients physicians before any decision is made. An oral care provider preparing a patient for surgery has to consult with the physician to determine the risk-benefit ratio at potential as well as deciding on changing the drug regimen.

Periodontal Processes

There is an increased risk of bleeding occurring from the hypermic gingival tissues. This is very common for patients with bleeding disorder. That is the reason as to why most oral health care providers emphasize on the essentiality of periodontal health. It is very critical for individuals with bleeding disorders. Absence of this care leads to teeth mobility which in the long run leads to extraction of the teeth. Tooth extraction may turn out to be a complicated and difficult to achieve fetish for patients with bleeding disorders. Most of the patients, especially those with coagulopathies usually avoid brushing or tooth flossing due to the fear of bleeding. Absence of these activities leads to increased chances of gingivitis as well as periodontitis.

There are measured practices that can be done without exposing the patient to a significant bleeding. Such activities include supragingival scaling as well as polishing. The best way of carrying out these procedures is by ultrasonic instrumentation. This reduces chances of tissue traumatization. Before deep scaling is carried out, mouthwashes are highly advisable for patients whose exhibited deep tissue inflammation.

Restorative Procedures

These procedures do not present a considerable risk of bleeding. However still, care needs to be taken when carrying out these procedures. Injuries to gingiva are very prevalent with these procedures, as such, the care is to avoid injuring the gingivi. Cutting instruments too may present injuries to the soft tissues. Therefore, rubber dam is recommended to avoid laceration of soft tissues, which are often very delicate. The saliva glad and mucosa found on the bottom of the mouth could be injured by saliva injectors. That is why care has to be taken. Oral care providers usually recommend endodontic therapy to patients with bleeding disorders other than carrying out extraction. This type of therapy has lower chances of causing bleeding, and can be carried out routinely.

Prosthodontics and Orthodontic Processes

Prosthodontics procedures do not pose a massive risk of bleeding. Post insertion adjustments are used to minimize trauma. The trauma on soft tissue as well needs to be handled carefully. On the other hand, orthodontic therapies are carried out without any instance of bleeding. It is more advisable since the chances of bleeding complication are very minimal. However, there should be outmost care to ensure that the appliances used do not damage the soft tissues.

Choice of Medicine

Much of the medications prescribed for dental practices, may end up interfering with the normal hemostasis. Most of these drugs interact positively with the anticoagulants and increases their prolific. This as well reduces the risks of bleeding. However still, some of these drugs prescribed for dental practices, may have effects when used for long. Therefore, oral care providers are overly urged to exercise necessary caution while administering these drugs. Therefore, for a patient with bleeding disorders, the choice of medication they take has an impact on their overall health.

Conclusion

To sum up, oral health is very essential in our lives. it is very critical to maintain our health. Defects caused by oral health could be controlled if people practiced proper health hygiene. Proper health hygiene involves regular visits to professional dental experts, flossing and regular brushing. Moreover, individuals need to include nutritional foods in their diet to increase their immunity. The impacts of oral health run all the way from personal challenges to economic lagging in a country. These diseases may affect an individual throughout their life time. This will reduce their activeness thus bringing an impact to the economy. Countries with low and middle income earners are mostly affected by oral health diseases. This is because those have limited access to medical information and medical services. In light of this, the world health organization undertook several measured and concrete strategies to help such countries. They are dedicated and committed into making oral health a top priority. Similarly, oral health care providers need to be on the fore front in understanding the impacts of these diseases. They need to be aware on how to handle different patients, especially those with bleeding disorders. However still, more research is needed to ascertain affordable ways that marginalized and low income population can adapt to prevent oral health diseases.