Local Anaesthetic Techniques Scottish Haemophilia Centres Buccal Infiltration - No cover required ■ Glasgow Comprehensive Care These can be used for anaesthetising all Haemophilia Centre upper teeth and also the buccal aspect of Glasgow Royal Infirmary lower premolars, canines and incisors. Castle Street The use of Articaine® may be considered Glasgow G4 0SF The Dental Management for lower molar teeth. Telephone: 0141 211 5127 of Adult Patients with Intra-papillary Injections Dental Department: 0141 531 8916 Haemophilia and No cover required Edinburgh Comprehensive Care Other Congenital These may be used for anaesthetising Haemophilia Centre Haemophilia & Thrombosis Centre Bleeding Disorders any teeth. OPD1 Intraligamentary Injections Royal Infirmary of Edinburgh No Cover Required Little France Crescent Edinburgh EH16 4SA The use of these injections should not Direct line: 0131 242 1270 cause any problems in patients with Out of hours contact: 0131 536 1000 congenital bleeding disorders. It is not - ask to speak to the on-call haematologist. a technique that is in common use since Tayside Haemophilia Centre there is a very slight risk of bleeding into Ward 34 Day Area the periodontal ligament, resulting in Ninewells Hospital & Medical School severe pain. Dundee DD1 9SY Telephone: 01382 660111 bleep 4072 Direct line / voicemail: 01382 632225 Dental team, based at Dundee Dental Hospital 01382 381600. Inferior Dental Block - Cover Required Grampian Area Haemophilia Centre The inferior alveolar nerve block should Haematology Day Unit only be required for treating the Ward 307 mandibular molar teeth. If it is required Aberdeen Royal Infirmary the patient may require appropriate cover Foresterhill by the haemophilia unit. Aberdeen, AB25 2ZN Telephone: 0845 456 6000 Lingual Infiltration - Cover Required Special Care dentistry: 01224551901/551084 If a lingual infiltration is required the Haemophilia Centre patient must have the appropriate cover. Haematology Outpatients Department Raigmore Hospital Old Perth Road

Inverness, IV2 3UJ GUIDANCE FOR DENTAL PRACTITIONERS Telephone: 01463 704020 Review Date August 2017 276365 All patients with haemophilia and other Routine Dental • Endodontics congenital bleeding disorders are A thorough medical and dental history and This should not cause problems registered with a haemophilia centre comprehensive examination are the basis although there is sometimes some and are advised to see a dentist every of good preventative care and should be bleeding at the apical foramen where six months if they have any of their own an essential component of the dental care vital pulp is present. This may continue teeth and every two years if they are of all patients with a congenital to bleed for some time and cause pain. wearing complete dentures. They will be bleeding disorder. The use of sodium hypochlorite for reviewed in the hospital dental The guidance refers to those with mild irrigation and calcium hydroxide paste department every two years as part of haemophilia and carriers who may be as the canal medicament appears to their ongoing medical care. It is not treated in either the general or reduce this problem. necessary for this to be carried out by the public dental services. hospital-based service for all patients: • Extractions and Surgery • All moderate and severely affected Prevention Advice In most cases this will have to be carried patients should receive all their dental Re-enforce preventative advice at each visit. out in the hospital environment to allow the administration of the treatment in the hospital environment. Include dietary information and the use of In special circumstances treatment may appropriate cover and immediate post fluoride toothpaste and treatment operative care. The haemophilia centre be provided by the Public Dental Service where appropriate. will confirm this. providing there is close liaison with the • Hygiene Therapy haemophilia centre. • Orthodontic Treatment It is very unlikely that a routine scale • All other patients can have the majority Fixed and removable orthodontic and polish including the use of of their treatment provided by either appliances may be used along with ultrasonic scaling will cause any the General Dental Service or the Public regular preventative advice and prolonged bleeding. However, if the Dental Service, with appropriate liaison hygiene therapy. gingival and periodontal condition is with the local haemophilia centre. very poor cover may be required to Local Anaesthesia control bleeding. Dental Care Intravenous coagulation factor concentrates Individuals are at risk from conditions • Removable Prosthetics are usually only required when an inferior affecting both hard and soft-tissues. The Treatment is unlikely to cause dental nerve block or a lingual infiltration is management of dental disease may any problems. required. The requirement for such cover require the use of intravenous clotting may alter depending on the proposed • Restorative Dentistry factor concentrates and therefore dental treatment. It is essential that an prevention is of the utmost importance. Restorative dentistry, including the aspirating technique must be used at The commonest diseases are periodontal provision of crowns and bridges, can be all times. disease, dental caries and tooth wear. carried out safely provided the local anaesthetic guidelines are followed (overleaf).