Rasaratnam L, Chowdary P, Pollard D, Subel B, Harrington C, Darbar U R
Department of Restorative Dentistry, Eastman Dental Hospital, London, UK.
Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK.
Haemophilia. 2017 Mar;23(2):247-254. doi: 10.1111/hae.13122. Epub 2017 Jan 16.
Successful outcomes in dental management for patients with inherited bleeding disorders require close collaboration between haematology teams and dentists.
To review outcomes of an interdisciplinary pathway for dental procedures by assessing adequacy and appropriateness of haemostatic management.
Two hundred dental procedures in 30 patients with inherited bleeding disorders were included. A Dental Bleeding Risk Assessment and Treatment Tool (DeBRATT) was developed to identify four categories of bleeding risk (no risk, low, moderate and high risk of bleeding) in relation to the severity of the bleeding disorder and the invasiveness of dental procedure. The adequacy and appropriateness of haemostatic therapy provided in relation to the bleeding risk was assessed with reference to the published literature. Treatment was classified as appropriate, over or under-treatment. Bleeding complication was the primary outcome.
A high level of dental disease was noted, with 83% of patients having at least one decayed tooth and 46.7% having chronic gum disease. A total of 59.1% of the dental procedures in patients with mild bleeding disorders were over-treated (n = 65/110) and 8.9% in patients with severe disorders had an extended duration of treatment (n = 7/79). One bleeding complication was observed in a patient with Von Willebrand's disease and severe thrombocytopenia. All other procedures (99.5%) were uneventful.
DeBRATT enables a risk-based approach for the management of dental procedures in patients with inherited bleeding disorders. The tool facilitates a comprehensive evaluation of bleeding risk with the potential to minimize unnecessary treatment and aid interdisciplinary communication among different clinical teams.
遗传性出血性疾病患者的牙科治疗成功需要血液学团队和牙医之间密切合作。
通过评估止血管理的充分性和适当性，回顾牙科手术跨学科路径的结果。
纳入30例遗传性出血性疾病患者的200例牙科手术。开发了一种牙科出血风险评估和治疗工具（DeBRATT），以根据出血性疾病的严重程度和牙科手术的侵入性确定四类出血风险（无风险、低、中度和高出血风险）。参照已发表的文献评估针对出血风险提供的止血治疗的充分性和适当性。治疗分为适当、过度或不足治疗。出血并发症是主要结局。
发现牙科疾病水平较高，83%的患者至少有一颗龋齿，46.7%的患者患有慢性牙龈疾病。轻度出血性疾病患者中，共有59.1%的牙科手术治疗过度（n = 65/110），重度疾病患者中有8.9%的治疗时间延长（n = 7/79）。一名患有血管性血友病和严重血小板减少症的患者出现了一例出血并发症。所有其他手术（99.5%）均顺利进行。
DeBRATT为遗传性出血性疾病患者的牙科手术管理提供了一种基于风险的方法。该工具有助于全面评估出血风险，并有可能最大限度地减少不必要的治疗，并促进不同临床团队之间的跨学科沟通。
