Key Points
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This pilot study is small and lacks the power to recommend changes in clinical practice. A larger multi-centre study may be the solution.
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The results from this study promise the possibility of reducing the need of using factor replacement therapy on a minor traumatic procedure in people with haemophilia.
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It gives the patients more freedom in determining their own treatment; reserve factor for more severe bleeding situations; thus
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avoiding the disadvantages of factor replacement therapy (high cost, development factor antibodies and risks of blood product contamination).
Abstract
Aims To compare the effectiveness of tranexamic acid mouthwash (TAMW) in controlling gingival haemorrhage after dental scaling with that of using factor replacement therapy (FRT) prior to dental scaling in people with haemophilia.
Design Double-blind cross-over randomised control trial.
Setting Dedicated hospital dental practice for patients with inherited bleeding disorders.
Method Sixteen patients with haemophilia who required dental scaling participated in this pilot study. The experimental treatment regime (ETR) involved transfusing each patient with saline before scaling both quadrants on one side of the mouth followed by oral rinsing with TAMW four times daily for up to eight days. The control regime (CR) involved giving each patient FRT before scaling the opposite side of the mouth followed by use of a placebo TAMW. Each patient underwent both treatments in a random-ised sequence. Both the operator and the patients were unaware of which were the ETR and CR episodes. On both occasions the patient kept a log book of the rinsing regime and any post-operative bleeding. Additionally, a structured post-treatment telephone interview was conducted to assess the effectiveness and the patient acceptability of the ETR.
Results Thirteen patients completed the study. No statistically significant difference was found in gingival bleeding and mouthwashing frequencies between the ETR and the CR (p > 0.05). Five patients reported no gingival bleeding with either the ETR or the CR. No patient, using either regime, required extra FRT due to gingival haemorrhage. All subjects found the ETR acceptable and easy and reported feeling safe in using TAMW alone to control gingival bleeding after dental scaling.
Conclusion TAMW use after dental scaling was as effective as using FRT beforehand in controlling gingival haemorrhage for people with haemophilia.
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Acknowledgements
This study was made possible by the financial assistance of the 2000 Shirley Glasstone Hughes Memorial Prize Fund of the British Dental Research Foundation. The authors also wish to thank the patients, Ms Muna Savage (hygienist) and staff at both the Dental Clinic and the Haemophilia Reference Centre at St Thomas' Hospital for their involvement in this project.
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Lee, A., Boyle, C., Savidge, G. et al. Effectiveness in controlling haemorrhage after dental scaling in people with haemophilia by using tranexamic acid mouthwash. Br Dent J 198, 33–38 (2005). https://doi.org/10.1038/sj.bdj.4811955
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DOI: https://doi.org/10.1038/sj.bdj.4811955
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