A routine tooth extraction or deep cleaning, often considered a simple outpatient procedure, can become a life-threatening emergency for people with haemophilia (PwH) if adequate precautions are not taken. A new review has cautioned that many dentists are unfamiliar with managing patients with the inherited bleeding disorder, leading to delayed treatment, inconsistent clinical practices and, in some cases, severe postoperative bleeding.
Published in The Open Medicine Journal, the review synthesises current evidence and clinical recommendations to help dental professionals provide safer care for haemophilia patients.
The study was led by Dr. Amit Kumar of the Department of Public Health Dentistry at Santosh Dental College, Santosh Deemed-to-be University, Ghaziabad. The authors include Dr. Sanjeev Kumar Singh and Dr. Abhilasha Smith of SMMH Government Medical College, Saharanpur; Dr. Ajit Vishwakarma of Government Medical College, Azamgarh; and Dr. Meena Jain of Santosh Dental College.
Haemophilia is a hereditary bleeding disorder caused by the deficiency of clotting factors essential for blood coagulation. People with the condition are unable to form stable blood clots, making them vulnerable to prolonged bleeding even after minor injuries or routine medical procedures.
While the condition affects multiple aspects of healthcare, dental treatment presents unique challenges because procedures frequently involve the gums, soft tissues and bone, all of which are highly vascular.
According to the review, haemophilia A—the more common form caused by a deficiency of clotting factor VIII—affects about one in every 5,000 male births worldwide. Haemophilia B, caused by factor IX deficiency, is less common but poses similar risks during invasive dental procedures.
The authors noted that fear of excessive bleeding often discourages patients from seeking regular dental care or even maintaining routine oral hygiene. Avoiding brushing and flossing because of bleeding concerns can increase the risk of tooth decay and gum disease, eventually making invasive procedures such as tooth extractions unavoidable.
"Preventive dental care is therefore particularly important for people with haemophilia," the review said, adding that regular check-ups, professional cleaning, fluoride application and fissure sealants can significantly reduce the need for surgical dental procedures later in life.
For dentists, however, treating haemophilia patients requires considerably more planning than routine dental care.
Before undertaking any invasive procedure—including tooth extractions, deep scaling or certain local anaesthetic injections—the patient's type of haemophilia, disease severity and treatment history must be carefully evaluated. Equally important is determining whether the patient has developed inhibitor antibodies that reduce the effectiveness of standard clotting factor replacement therapy.
The review emphasised that treatment planning should be carried out in close consultation with a haematologist. Clotting factor replacement before and after dental procedures remains the cornerstone of safe management for many patients. Depending on the individual's condition, additional local measures such as absorbable sutures, collagen or gelatin-based haemostatic sponges, fibrin sealants and tranexamic acid mouthwashes can further reduce the risk of prolonged bleeding.
The authors also highlighted advances in haemophilia treatment that are reshaping dental management. Newer therapies, including extended half-life clotting factor concentrates and bispecific antibodies such as emicizumab, have improved bleeding control for many patients. Experimental gene therapies, though still evolving, hold the promise of correcting the underlying genetic defect, potentially transforming long-term management.
These developments, the review said, mean dentists need to remain updated on current treatment protocols rather than relying solely on traditional approaches.
Dental lasers may also offer an advantage by minimising soft tissue bleeding during certain procedures, the authors note.
Recognising that many dental practitioners rarely encounter haemophilia patients in routine practice, the review provides a practical clinical decision guide covering pre-treatment assessment, procedure-specific precautions, local haemostatic techniques, postoperative care and medication choices.
Pain management is another important consideration. The review advised that paracetamol should generally be preferred for pain relief, while aspirin and several non-steroidal anti-inflammatory drugs should be avoided because they interfere with platelet function and can increase the risk of bleeding.
The review also underscored the importance of communication between dentists, haematologists and patients. Coordinated care, the authors argue, is essential to minimise complications and ensure that necessary dental treatment is not postponed out of fear.
While the authors acknowledged that their work is a narrative review rather than a systematic review, they said it highlights a clear need for greater awareness and standardised clinical protocols. They call for enhanced training of dental professionals so that patients with haemophilia can receive timely, safe and evidence-based dental care.
The review concluded that with appropriate planning, preventive care and multidisciplinary coordination, most dental procedures can be performed safely in people with haemophilia, reducing both the risk of serious bleeding and the need to defer essential oral healthcare.
