Let’s Not Forget the Importance of Dental Care

Originally published on Hemophilia News Today by BioNews, Inc.

I’m diligent about oral healthcare. I use an electric toothbrush, floss every day, and visit my dentist every three months. My reasons for this diligence are many, but mostly I am afraid of bleeding from dental procedures.

Mouth and gum bleeding are common for those living with von Willebrand disease and hemophilia. Some federally funded hemophilia treatment centers even provide dental care as part of their services. I don’t need to medicate before a dental cleaning. However, oral surgery and injections pose a bleeding threat.

Oral surgery

I’m no stranger to dental issues. In middle school, an oral surgeon pulled four of my teeth for braces in a hospital under anesthesia. At the same time, I had minor knee surgery. There wasn’t much bleeding during the surgery, but I oozed from my mouth and knee for weeks afterward.

At times, my knee and my mouth would bleed simultaneously. Blood would frequently seep through the wrap and dressing on my knee. There was no pain, but the sight of blood coming through the bandage was enough for the school nurse to send me home.

I played the flute in the band and became adept at playing while clamping down on gauze to stop the bleeding. The blood-soaked gauze must have been so gross for my classmates to witness.

When I was in my early 20s, I had all four wisdom teeth pulled. Because of the bleeding problems years earlier, the oral surgeon refused to remove my wisdom teeth until I visited my hematologist to define a better treatment plan. He pulled my teeth without incident, thanks to the plan to raise my factor levels for the 10 days following surgery.

The long needle

In my 30s, I was in my “let’s ignore that I have a bleeding problem” phase of life. Past treatment had put me at risk for HIV and hepatitis. I’d be damned if I would have any factor, fresh frozen plasma, or cryoprecipitate infused into my veins.

I had a cavity in one of my back molars during this time. A shot with a long needle, called a mandible nerve block injection, was used to numb the area before the filling. I didn’t mention my bleeding problems to this dentist, consistent with my “ignore the problem” phase.

As soon as the needle pierced my skin, I felt a warm, tingling sensation in my jaw and searing pain, different from anything I had ever felt before from dental work. A few minutes later, I was numb. The dentist asked me to open my mouth so he could begin. I tried, but my mouth wouldn’t open but maybe a centimeter or two. I tried again — still, my jaw would not respond to my muscles trying to pry my mouth open.

Yelling at the dentist through my clenched jaw was a comical effort in futility. What was happening? I started to panic. Would this be my life from now on? Was my mouth permanently closed? All weight loss and “you talk too much” jokes aside, I was genuinely terrified.

The dentist was as frustrated as I was. He said he had never seen this happen before. He got out a device to help keep my mouth open the little that it could and proceeded to work on my tooth. Unsurprisingly, weeks later, the filling had to be redone. I should have run when my jaw locked up.

Jaw bleed

When I visited a new dentist, he asked about my bleeding disorders and for permission to speak with my hematologist. They concluded that I had a jaw bleed caused by the injection for the filling. This incident caused permanent damage to my jaw. My mouth does open, but not as much as before. Thankfully, I have not needed any procedures that require a mandible block injection since, but you can be sure I will medicate ahead of time if I do.

If you live with a bleeding disorder, I implore you not to ignore your oral health. Be upfront with your dentist about your condition, and be sure to involve your hematologist in your dental care when needed.

Note: Hemophilia News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Hemophilia News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to hemophilia.