Bleeding disorder (hemophilia, von Willebrand disease)

Oral health effects

• Prolonged post-surgical bleeding

  Delayed or absent clot formation causes prolonged bleeding after extractions or other invasive procedures.

  Mechanism: Deficient or dysfunctional clotting factor (factor VIII/IX in hemophilia A/B, von Willebrand factor in vWD) impairs the coagulation cascade or platelet adhesion.

  Clinical management: Coordinate with the patient's hematologist for factor replacement or desmopressin (DDAVP) coverage before invasive procedures; use local hemostatic measures (e.g., tranexamic acid rinse) postoperatively.

• Spontaneous gingival bleeding

  Gingival bleeding can occur with minimal plaque irritation, especially in severe factor deficiency.

  Clinical management: Reinforce gentle, effective hygiene; investigate bleeding disproportionate to plaque levels.

• Deep bruising/blood pooling after nerve-block injections (hematoma)

  Inferior alveolar nerve blocks and other injections into muscle or soft tissue carry a higher risk of hematoma than infiltration anesthesia in this population.

  Clinical management: Prefer infiltration or intraligamentary anesthesia where feasible; ensure systemic hemostatic coverage is in place before a block injection.

• Bleeding into the jaw joint (TMJ hemarthrosis, severe disease)

  In severe hemophilia, bleeding into the temporomandibular joint can cause pain and limited opening.

  Clinical management: Refer for medical evaluation if TMJ pain or limited opening occurs without a clear dental cause.

• Plaque buildup and gum disease from avoiding brushing (poor oral hygiene / periodontal disease)

  Fear of provoking gum bleeding leads some patients to brush and floss less, and most studies that compared periodontal status found it worse than in healthy controls; caries findings are mixed.

  Clinical management: Reassure patients that gentle daily brushing and interdental cleaning reduce, not increase, gingival bleeding over time; use a soft brush, give tailored OHI and fluoride, and keep short recall intervals so invasive periodontal therapy (which needs hematology planning) is less likely to be needed.