Dental Considerations in Children with Inherited Bleeding Disorders and Inhibitors: A Systematic Review

Area of Science:

• Pediatric Hematology
• Dental Medicine
• Systematic Review Methodology

Background:

• Children with inherited bleeding disorders and inhibitors face significant risks of oral bleeding during dental treatments.
• Existing hematological treatment protocols and local hemostatic measures require evaluation for their effectiveness in this vulnerable population.
• There is a need to assess the impact of newer prophylactic treatments on managing dental complications.

Purpose of the Study:

• To systematically review the effectiveness of hematological treatments and local hemostatic measures for preventing oral bleeding in children with inherited bleeding disorders and inhibitors during and after dental procedures.
• To identify and evaluate current management strategies and their outcomes.
• To highlight gaps in current dental care protocols for this patient group.

Main Methods:

• Systematic literature search across PubMed, Google Scholar, Web of Science, Scopus, and Cochrane Library (January 2000 - February 2024).
• Inclusion of various study designs including RCTs, observational, cohort, case-control, and cross-sectional studies.
• Data extraction focused on study characteristics, interventions (e.g., Emicizumab, recombinant factor VIIa, local hemostasis), complications, and outcomes.

Main Results:

• Five studies involving children aged 2-18 years were included, addressing hemophilia A with inhibitors and other inherited bleeding disorders.
• Emicizumab demonstrated significant efficacy in reducing bleeding episodes, hospital admissions, and improving quality of life.
• Various prophylactic and treatment measures, including Emicizumab and recombinant factor VIIa, were assessed for their impact on postoperative bleeding.

Conclusions:

• Significant gaps exist in the standardized management of dental care for children with inherited bleeding disorders and inhibitors.
• Integration of novel prophylactic treatments like Emicizumab into standardized protocols is essential.
• Updated protocols can substantially decrease bleeding complications associated with dental procedures in these children.