DENTAL MATTERS This has been produced by Bayer
WHY IS GOOD DENTAL CARE IMPORTANT FOR HAEMOPHILIA?
Haemophilia doesn t directly affect the teeth. However, like everyone else it is important to brush and floss your teeth every day to protect against decay. Neglecting these basics can also have a significant impact on the gums. If people with haemophilia develop gum disease, as a result of poor oral hygiene, they can experience gum bleeds that may last for some time. WHERE CAN I FIND A SUITABLE DENTIST? Most dentists will treat people with haemophilia, but some may choose not to. You can ask your local haemophilia centre to help you identify the suitable dentists in your area. When you find one, make sure you tell the dentist about your condition and show him/her the Bleeding Disorder Information Card you were given from your haemophilia centre. Ask your haemophilia centre healthcare professionals about this if you do not have one.
WHAT CAN I DO TO LOOK AFTER MY TEETH AND GUMS?
Some general tips and advice on how to look after your teeth and gums include: 1. Avoid sugary snacks and drinks between meals. Sweets, chocolate and sugary drinks tend to encourage the build-up of plaque in the mouth, which damages the teeth and gums. The best option to satisfy any sugar cravings is to choose healthy foods like fruit instead; the natural sugars found in fruit can cause less damage than refined sugars in processed foods. You can also ask your doctor to prescribe sugar-free medicines. 2. Brush your teeth twice a day, for at least 2 3 minutes each time. A brushing routine that cleans the gums and teeth in the top and bottom of your mouth is the best way to protect you from gum disease and tooth decay. 3. Use a medium texture toothbrush with a small head, or an electric toothbrush. Having a smaller head on the brush makes it easier to reach all parts of the mouth. Electric toothbrushes tend to be more effective at removing plaque compared to brushing with a manual toothbrush. 4. Use dental floss, dental tape or inter-dental brushes daily to remove particles of food between the teeth. Ask your dentist to show you how to use these products if you are not sure. 5. Visit your dentist for regular check-ups every six months, so that any problems you may have with your teeth or gums can be identified early. You should always contact your dentist if you notice anything unusual in your mouth (e.g. dark spots on your teeth; this is an indication of tooth decay), or if you experience any pain or discomfort. 6. Fluoride toothpaste with or without mouthwash is recommended, although you should check with your dentist first. The best products to use have a fluoride content of 1350-1500 parts per million (ppm). 1 Although 1000 ppm should be used for children under 3 years. 3
WHAT IS AN IDEAL BRUSHING ROUTINE?
Place the toothbrush against your gums with the bristles pointing towards the roots of your teeth. Next, twist the brush so that the bristles sweep over your gums and towards the biting surfaces of your teeth. Repeat as necessary. Clean behind the front teeth by holding the toothbrush at a 45-degree angle, and using an up and down brushing motion with the whole length of the toothbrush head. Brush the top surface of the teeth by holding the toothbrush horizontally, and using a back and forth scrubbing stroke. Apply a little pressure when brushing, to make sure the bristles of the toothbrush reach into the furrows of the teeth.
IS THERE ANYTHING I SHOULD BE AWARE OF?
Just like everyone else it s important to keep your mouth clean, especially after tooth extractions and other dental surgery. Poor dental hygiene can lead to bleeding gums, tooth decay and a whole range of other complications that may require surgery if left unattended. Some common problems that people often experience in the mouth are listed below, as well as some advice on what you should do if you experience them. GUM PROBLEMS Bleeding gums Bleeding gums are one of the first signs of gingivitis or gum disease, which can be prevented by brushing your teeth and flossing regularly. If you experience bleeding, contact your dentist and haemophilia centre. It is important to note that healthy gums do not generally bleed during brushing and flossing, although some bleeding may occur if you re overly aggressive with your toothbrush. To prevent this happening, try using a toothbrush with a medium textured head. If you have a small amount of bleeding continue brushing because plaque, which is removed by brushing, is the main cause of gum disease. If you have more bleeding or are concerned then contact your local haemophilia centre. To stop the bleeding, you may be advised to rinse your mouth out with tranexamic acid mouthwash. You may also be prescribed tranexamic acid tablets to use in conjunction with the mouthwash from your doctor. Tranexamic acid helps stop bleeding by preventing enzymes (proteins) in the body from breaking down blood clots. Both tranexamic acid mouthwash and tranexamic acid tablets, can be obtained from the healthcare professionals at your haemophilia centre. Plaque Gum line Reduced gum line
Mouth ulcers Mouth ulcers can be treated using non-prescription medicine from the chemist, and should clear up within a few days. Contact your dentist if your mouth ulcer is more severe than normal, starts bleeding heavily, or persists for longer than a few days. If any light bleeding occurs, contact your haemophilia centre. You may be advised to rinse your mouth out with tranexamic acid. DENTAL PROBLEMS Sensitive teeth Over-enthusiastic brushing or diets rich in acidic foods and drinks are largely responsible for tooth hypersensitivity; they wear away the outer layer of the teeth (the enamel) and expose the dentine underneath. However, receding gums and gum disease can also play a major role in tooth sensitivity. In this instance, the dentine of the teeth is exposed as the gums withdraw. Dentine is made of tiny tubules that allow stimuli such as hot, cold or sweet food to reach the pulp of the tooth (i.e. the nerve centre), causing pain.
To reduce sensitivity it is important, as always, to maintain good oral hygiene. Other tips include: 1. Using a soft bristled toothbrush to reduce further abrasion and gum irritation when brushing. Brush gently and carefully around the gum line so you do not remove more gum tissue. 2. Using de-sensitising toothpaste. With regular use you should notice a decrease in sensitivity. 3. Watching what you eat. Try to avoid highly acidic food or drink. Your dentist should be able to advise you on what foods and drinks to avoid. 4. Using fluoridated dental products. 1 5. See your dentist every 6 months and ask for professional tooth cleaning and oral hygiene instructions. Toothache Toothache could be the first sign that you need a filling. Your dentist should identify any problems with your teeth during your regular 6-monthly check-ups. However, if you experience any discomfort you should make an extra appointment for an examination. Dark, blue/black or brown spots on the teeth can indicate tooth decay, meaning that the build-up of plaque on the teeth has led to the destruction of the dentine and enamel. Pain is caused by the infection irritating the nerves of the teeth. Pain which is prolonged and severe usually means that the decay has reached the nerve of the tooth. The tooth would then either need to be root-filled or removed by a specialist dentist.
WHAT HAPPENS IF I HAVE PROBLEMS WITH MY TEETH OR GUMS?
If you require any dental work that carries the risk of causing a bleed (e.g. tooth extractions, fillings etc), you will need to see a specialist dentist. When this happens either you or your dentist can contact your local haemophilia centre, which will put you in touch with a specialist dentist. These dentists usually work within haemophilia comprehensive care centres. The only difference between your treatment, and that of a person without haemophilia, is that you may have to have blood tests before and after the procedure to check your clotting factor levels. You may also need to be given extra clotting factor if your levels are low. WHAT IF MY CHILD HAS HAEMOPHILIA? Having haemophilia does not affect teething in babies, or the loss of milk teeth. However, if your child develops bleeding gums, contact your local haemophilia centre. Persistent mouth bleeds may be treated with tranexamic acid. As soon as teeth erupt in the mouth, brush them twice daily with a soft toothbrush. For children up to 3 years of age, use a smear of fluoride toothpaste, no less than 1,000 ppm, and a pea-sized amount for those over 3 years. 1,2 Children over 6 years of age should use toothpaste with a fluoride concentration of 1350-1500 ppm. References: 1. Marinho VC et al. Cochrane Database Syst Rev 2003;(1):CD002278. 2. Hinds K and Gregory JR. 1995 National Diet and Nutrition Survey; children aged 1.5 to 4.5 years. The Stationery Office, London. 3. Delivering Better Oral Health - An evidence-based toolkit for prevention - Second Edition. April2009. Department of Health & British Association for the Study of Community Dentistry. [http://www.dh.gov.uk/en/publicationsandstatistics/publications/ PublicationsPolicyAndGuidance/DH_102331]
WHAT SUPPORT DOES BAYER OFFER? Additional information can be found at: www.factorfitness.co.uk
Bayer is committed to haemophilia research and supporting people with haemophilia: Funding research to advance the successful management of haemophilia Reducing needle sizes and infusion volumes to aid infusion Producing infusion aids such as stress balls and tourniquets to support patients with their infusions Creating leaflets and materials to support patients through their journey with haemophilia Developing the interactive website www.factorfitness.co.uk 15
With thanks to Dr Kate Khair, Consultant Nurse, Haemophilia, Haemophilia Comprehensive Care Centre, Great Ormond Street Hospital, UK.; Carol Mason, Consultant in Paediatric Dentistry Great Ormond Street Hospital for Children NHS Trust. For further information contact: Bayer plc, Bayer House, Strawberry Hill, Newbury, Berkshire RG14 1JA. Tel: (01635) 563000. Bayer plc June 2016. Registered trademark of Bayer AG, Germany. Bayer and are trademarks of Bayer AG. June 2016 L.GB.MKT.03.2016.15325a