If you have hemophilia, you don't have enough blood-clotting proteins – also known as clotting factors – in your blood. Therefore, it takes your body longer than it should to stop bleeding after an injury, surgical wound, or other open wound.

Dentists often prefer the use of endodontic (restorative) treatment, such as root canal treatment, as an alternative to tooth extraction for patients with hemophilia. Restorative treatment to repair a broken, infected, or badly decayed tooth has less risk of bleeding complications than extractions or other more invasive options. But even a minor bleeding episode can become more serious for a hemophiliac. Consequently, your dentist needs to take certain precautions if you need a dental procedure such as a root canal.

Understanding What the Procedure Involves

During a root canal, infected pulp (the soft tissue inside a tooth) and decayed nerve tissue are removed through a hole the dentist drills in the crown of the affected tooth. Once debris is cleaned from inside the tooth's root canals, your dentist will fill and seal the area to save the remainder of the tooth. But before performing the procedure, he or she should consult with the hemophilia treatment center or hematologist who treats you to get complete information regarding your medical history.

Receiving Clotting Factor Replacement Therapy

Depending on the severity of your condition and how much clotting protein is circulating in your blood, you may need factor replacement therapy – blood products that increase the clotting factor in your blood – before and/or after the dental procedure. Before the procedure and following a consultation between your dentist and doctor, you may require blood tests to check your blood-clotting protein factors and help calculate the risk of severe bleeding during dental work.

If you have mild hemophilia and bleed infrequently, you may need to receive clotting concentrates intravenously in the hospital. However, if you are a moderate to severe hemophiliac, it's likely that you've been trained in administering clotting concentrates at home and may be able to infuse a clotting factor concentrate yourself.

Generally, dental surgery and invasive dental procedures for hemophiliacs that pose a risk of uncontrolled bleeding should always be done in a hospital setting. But if you don't have severe hemophilia, a dental procedure, such as a root canal, can sometimes be performed safely in the dentist's office.

Proceeding With Caution

Your dentist will calculate the working length of the root canal by taking X-rays before before the procedure. This reduces the risk of dental instruments, including the wire-like endodontic files, from damaging soft tissue in the mouth or passing through the root end of the root canal, causing bleeding.

When the dental tools a dentist uses during restorative treatments cause bleeding, the use of topical agents often is enough to control the bleeding if you have hemophilia A – also known as classic hemophilia. Dentists generally don't use high speed suction during root canal treatment on patients with hemophilia. The use can injure the oral mucosa lining the mouth, causing hematoma – blood that seeps outside of blood vessels.

Normally, the root canal procedure is safe, even for individuals with hemophilia. The key is to talk to both your doctor and dentist beforehand. Your hematologist and dentist also should talk to each other to plan the steps necessary to minimize your risk of bleeding and ensure a safe procedure.

Your doctor may recommend taking aminocaproic acid – a drug used to control severe bleeding – prior to the dental procedure, but after taking the required dose of clotting factor. The antifibrinolytic agent keeps the clot that forms if bleeding occurs during or after root canal treatment from breaking down too soon.

For more information, contact John S. Lyon DDS or a similar dental professional.