Oral bleeding in classic hemophilia

Resident’s Name: Brian Schmid DMD Date: 7/31/09
Article title: Oral bleeding in classic hemophilia
Author(s): AL Sonis DMD. RJ Musselman DDS
Journal: Oral Surgery
Month, Year: April 1982
Major topic: Diagnosis of hemophilia in the dental setting
Type of Article: Retrospective analysis
Findings: 132 charts from three hospitals in Louisiana were chosen and reviewed for severity of hemophilia, age and manner of diagnosis and need for factor infusions secondary to bleeding episodes. 29% had mild hemophilia, 40% moderate and 31% severe. Their average age of diagnosis was 14 months, 8 months and 6 months. 13.6% of all cases were diagnosed due to persistent oral bleeding, most commonly mild hemophilia (28.6% of all mild cases). The most common site of oral bleeding was the lip frenum with 78% and the tongue 22%. Overall, 9% of factor infusions were due to persistent oral bleeding; 60% with the lip frenum, 23% the tongue, 17% the buccal mucosa and 0.5% the gingival and palate.
The diagnosis of hemophilia due to persistent oral bleeding is logical since in the first year of life, the mouth and face are the most common sites of injury and most cases of hemophilia, particularly mild and moderate, are diagnosed after an acute bleeding event. Also, it fits that even severe hemophilia is not diagnosed until after 6 months since this is the time most babies will begin to crawl, shuffle, grab and stand, giving them ample opportunity for orofacial injury. Slightly more severe trauma may be found in toddlers who are now learning to walk, albeit precipitously, and correspondingly mild hemophilia patients are most often diagnosed around 14 months. Bechner and Strauss found that only 13% of mild hemophiliacs had a major bleeding event in the first year of life, while 30.5% had experienced one by 18 months.
Key points/Summary: About 14% of all cases of hemophilia are diagnosed after a chief complaint of persistent oral bleeding, most commonly mild hemophilia. Therefore it is well within the scope of pediatric dental practice to be wary of hemophilia and to screen for it when persistent oral bleeding occurs.
Assessment of article: A thorough and well thought out article with applicable knowledge supported by good research.