Dental care

Prevention of dental problems

Everybody is at risk of dental problems. However, the management of certain types of dental disease may cause bleeding. Therefore, preventing dental disease is very important. The most common diseases are periodontal disease (gum disease), dental decay and tooth wear.

If you are currently not registered with a dental practice, visit the NHS webpagepage to help find an NHS dentist in your area. Alternatively, you can search for a private dentist of your choosing.

Dental treatment

The majority of your treatment will not cause significant bleeding and may be carried out by a general dental practitioner (dentist).

It is important to understand that you may not need to attend the hospital for all your dental treatment.

If you have any questions about your dental treatment, please contact the Haemophilia Specialist Nurses:

Email: oxford.haemophiliaclinic@ouh.nhs.uk

Tel: 01865 225316

Dental surgery

If you are having dental surgery, tell your Haemophilia Team the type of surgery you are going to have (such as a tooth extraction), where you will have it, the date and time.

If your dental surgery is being carried out by your local dentist, discuss this with your Haemophilia Consultant or Specialist Nurse. They can advise if this is an appropriate route for your dental surgery and make a treatment plan for you and your dental surgeon.

If you need factor concentrate or other treatment and blood tests before your dental surgery, this may not be available at your local dentist or hospital - we will then recommend that your dental surgery is carried out in Oxford.

This may be at a community dental service, such as the East Oxford Dental Clinic in Cowley, or at the John Radcliffe Hospital.

This allows the Haemophilia Team to provide the necessary treatment before and afterwards, including blood tests and monitoring of any bleeding complications.

Most dental surgery is carried out as day case, so you should not need to stay in hospital overnight.

If you do not need dental surgery in a hospital, your dentist will need to refer you to the Oxfordshire Community Dental Service (OCDS) through Rego, the Dental Electronic Referral Service (DERS).

Where possible, the referral should include a full orthodontic treatment plan and copies of any X-rays you may have had.

Your dentist can still refer you if you do not live in Oxfordshire.

Referrals are no longer accepted for routine dental work, such as regular check-ups and hygienist visits, and once any surgery is complete you will be discharged back to the care of your local dentist.

If you do need dental surgery in a hospital, your dentist will need to refer you to the Maxillofacial surgeons at the John Radcliffe Hospital.

Private dental treatment

Currently OHTC cannot support patients having private dental interventions if factor is required. We would recommend that a private haematologist is consulted to support this.

The need for factor will depend upon the bleeding risk of your procedure.

Risks

Uncommon (low) risk of bleeding

• Examination (without basic periodontal examination (BPE) or periodontal pocket charting)
• Radiographs
• Prosthetics
• Prophylaxis (polishing of teeth)
• Supragingival and subgingival restorations without LA
• Restorations with buccal infiltration LA
• Supra-gingival crown and bridge work with buccal infiltration LA
• Supragingival scaling
• RCT with use of rubber dam clamp and buccal infiltration LA

Common (higher) risk of bleeding

• RCT first stage with open apex (paediatric or trauma cases)
• Subgingival restorations in a patient with unhealthy gingivae
• Subgingival crown and bridge work with or without the use of retraction cord
• Supragingival scaling in a patient with unhealthy gingivae
• Subgingival scaling and root surface debridement
• Any procedure requiring inferior dental block LA or lingual infiltration LA
• Single tooth extraction
• Multiple teeth extractions
• Minor oral surgery such as surgical extractions, periodontal surgery, implant surgery, biopsies.

Supporting information

Risk of bleeding for dental procedures. BPE: basic periodontal examination; LA: local anaesthetic; RCT: root canal treatment.

This information is adapted from the 2020 Guy's and St Thomas' NHS Foundation Trust guidelines for management of adult patients with congenital bleeding disorders undergoing dental treatment.

Emergency advice

For emergency advice or treatment when your dentist is closed please call 111.

• Monday to Thursday 6.30pm to 9.30pm
• Weekends 9.00am to 6.00pm
• Bank holiday weekends and bank holidays 9.00am - 5.00pm and 6.00pm - 9.00pm

This includes details of NHS dental practices offering emergency appointments.

Get dental help - NHS 111

Further information

Dental care for adults with a bleeding disorder - Haemophilia Society