Canterbury DHB

Context

Dental Procedures

Dosage levels depend on the precise nature of the procedure. The treatment regimen should be planned in consultation with the oral surgeon.

Nerve blocks (e.g., inferior dental nerve block) are not contraindicated provided satisfactory factor levels are achieved and there is close liaison between a haematologist and dental surgeon experienced in the management of haemophilia.

Infiltration local anaesthesia has a low risk of complications and periodontal (intraligamental) local anaesthesia can be used without risk.

In This Section

Routine Extraction with Local Anaesthetics

Dental Extraction with Surgical Flaps (General Anaesthesia)

Routine Extraction with Local Anaesthetics

Aim: To increase factor levels to 30%, follow-up treatment according to response.

Use local and/or systemic antifibrinolytic agents.

Treatment Regimen

FVIII 15 - 20 u/kg preoperatively, repeat dose next day if required.

FIX 30 u/kg preoperatively, repeat dose next day if required.

 

Tranexamic acid syrup (500 mg/5 mL) 5 - 10 mL 6 hourly, hold in mouth ³ 2 minutes before swallowing.

 

An alternative is to crush tranexamic acid tablets in warm water and use as a mouthwash. (This tastes more bitter than the syrup).

 

If not swallowed, consider giving additional systemic tranexamic acid tablets (1g four times a day orally)

Dental Extraction with Surgical Flaps (General Anaesthesia)

Aim: To increase factor level to 40 - 60%, with multiple dosing or continuous infusion.

Treatment Regimen

FVIII 20 - 30 u/kg preoperatively ® 20 u/kg @ 12 hrs ® 20 u/kg @ 24 hours

FIX 40 u/kg preoperatively ® 20 u/kg @ 12 hrs ® 20 u/kg @ 24 hours

 

Tranexamic acid syrup (500 mg/5 mL) 5 - 10 mL 6 hourly; hold in mouth ³ 2 minutes before swallowing. If not swallowed, consider giving additional systemic tranexamic acid (1g four times a day orally).

About this Canterbury DHB document (5251):

Document Owner:

Mark Smith (see Who's Who)

Issue Date:

August 2016

Next Review:

August 2019

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5251