Unique to You

About blood disorders

There are a wide variety of blood conditions that can affect the quantity or proper function of one or more primary parts of your blood, which include:¹

• Red blood cells that carry oxygen, vitamins, and nutrients to all parts of your body. These cells also pick up carbon dioxide from your cells and return it to your lungs to be exhaled.
• White blood cells that are produced in your bone marrow and found in your blood and lymph nodes. These cells are part of your immune system, and their primary function is to fight infection.
• Platelets that are small, colorless cells in your blood that work with clotting factors to form clots to stop or prevent bleeding.
• Clotting (coagulation) factors that are proteins circulating within blood plasma (the liquid part of your blood that moves cells and nutrients throughout your body). These factors work with platelets to form blood clots to stop internal and external bleeding.

Blood diseases are diagnosed in millions of people in the U.S. every year. Some are common; others are rare. Blood disorders are typically acquired genetically, but age, gender, pregnancy, and other medical conditions such as cancer or liver disease and their treatments can all increase your risk of developing acute or chronic conditions.

Blood disorders and your oral health

Undiagnosed or untreated blood disorders can have significant health effects. Many of these conditions show oral symptoms that your dentist can detect at an early stage. If your dentist identifies signs or symptoms of blood disorders and cannot rule out other causes, they will suggest you see a physician for further examination.²

Some of the more common blood disorders and the effects they can have on your oral health include:

• Anemia: This includes a variety of conditions related to the production of red blood cells, which transport iron and other vitamins and minerals throughout your body. Low production of red blood cells is commonly caused by vitamin B12 or iron deficiencies, autoimmune disorders, chronic kidney or other systemic diseases, or viruses such as HIV and malaria. When anemia prevents the soft tissue inside your teeth from getting the nutrients they need, that tissue may die and leave a hollow space open to the inside of your jaw bone. This has most frequently been reported in sickle cell anemia. If the tooth subsequently cracks or develops decay, bacteria can spread from the tooth into the surrounding tissues and jaw bone causing infection and pain. Anemia can also result in white patches in your mouth, increase the risk of infection, cause mouth sores, problems with your tongue³, and increase the risk of oral cancer.⁴ Since physicians do not normally look for these oral symptoms, your dentist can play an important role in early detection.
• Sickle cell disease (SCD): SCD includes a group of inherited red blood cell disorders that produce malformed red blood cells that restrict proper blood flow. It is one of the most common genetic disorders worldwide, affecting members of the black and Hispanic communities at a much higher rate than other races.⁵ Testing for SCD is standard at birth. When detected, SCD needs to be immediately and carefully monitored by dentists and physicians because it increases the risk of infection and abnormal bleeding. This can even affect infants and toddlers when teething or losing their primary teeth. SCD symptoms include discolored gums, slow tooth growth, weakened enamel, and swelling of the tongue. SCD can also increase your risk of periodontal disease.⁶
• Blood cancer: Hodgkins and Non-Hodgkin's lymphoma and leukemia affect your body's ability to produce healthy white blood cells. About 180,000 people in the U.S. are diagnosed each year with one of these diseases, accounting for nearly 10% of all new cancer cases.⁷ Cancer and its treatments can have severe effects on your oral health.
• Low white blood cell counts: Non-cancerous conditions, including autoimmune diseases like rheumatoid arthritis or lupus, or viral diseases such as HIV/AIDS, can also result in low white blood cell counts. You should always discuss possible symptoms and side-effects with your dentist and physicians.⁸
• Hemophilia: Hemophilia is a genetic disorder. It is most common in males and has been diagnosed in an estimated 33,000 people in the U.S. It is caused by the lack of specific clotting factors in the blood.⁹ Hemophilia can cause excessive bleeding when you brush, floss, or during routine or invasive dental treatment. It can also cause mouth sores and bruising of the lips and tongue.¹⁰
• Platelet disorders: Several conditions can result in low or abnormal production of platelets. These disorders can also be caused by a reaction to certain medications. Common oral effects of low platelet counts include excessive bleeding, bruising, or infections during routine oral hygiene or dental procedures. If you have a platelet disorder, you should encourage your dentist to discuss your condition with your primary care physician or hematologist prior to receiving dental treatment. This can help ensure that your dentist understands your situation so they can take proper steps to avoid unusual or excessive bleeding.
• Von Willebrand disease (VWD): This disorder results from low levels of specific proteins in the blood that prevent it from clotting properly. It affects 3.2 million people in the U.S.¹¹ VWD is most often inherited but can also be caused by other medical conditions like cancer or lupus. Like platelet disorders, VWD can impact both at-home oral hygiene and treatment received at dental visits. You may want to encourage your dentist to discuss your condition with your physician or hematologist prior to receiving dental procedures to ensure they understand your condition and take the proper steps to avoid potential complications.

Make oral health a priority

Blood disorders can dramatically affect your oral health and how you care for your mouth. If they cause discomfort or bleeding, these disorders can cause you to reduce your at-home oral routine or avoid visiting the dentist. This is concerning because these changes in behavior increase your risk of tooth decay or periodontal disease. If you have a blood disorder, it's especially important that you continue a regular oral health regimen at home and work with your dentist to develop thoughtful strategies to maintain good oral hygiene. These may include:

• Brushing at least twice a day with a soft-bristled brush and fluoride toothpaste. If your gums (gingiva) bleed, don't stop brushing your teeth. Bleeding gums may be a sign of inflammation or plaque build-up below your gum line, which requires more attention, not less.
• Flossing at least once a day to remove plaque from between teeth where brushes do not reach.
• Removing and cleaning dentures every day if you wear them.
• Drinking fluoridated water. If your dentist feels that you are not getting enough fluoride from your water sources, they may suggest fluoride supplements.
• Using antimicrobial rinses to help prevent infection.
• Keeping all of your dental appointments as recommended.

See your dentist regularly

At your visit, your dentist will examine for changes in the appearance of your tongue, gums, and surrounding tissues in your head and neck. These may be signs of a blood disorder, infection, or oral cancer. Your dentist will also note if you have excessive bleeding or if bleeding does not normally stop during or after a cleaning or other treatment.

• Before your appointment, you should tell your dentist about any blood disorders you have, as well as the medications you take for them. You should also mention any medications or supplements you take for other conditions, such as blood thinners. It is important to do this before you arrive for your appointment so your dentist can effectively plan your treatment and alter their approach to limit bleeding, discomfort, and the risk of infection if necessary. Depending on the severity of your condition, they may also need time to consult with your medical providers. In certain cases, your dentist may suggest you receive invasive dental treatment in a hospital setting where additional resources are on hand if needed.¹²
• Cancerous blood disorders require additional precautions to ensure safe and successful dental treatment. In extreme cases, dental treatment may not be recommended at all. Encourage your dentist and medical care providers to collaborate throughout your cancer treatment.
• Always follow your dentist's recommended schedule for appointments. For example, people with compromised immune systems may need to be seen more often for preventive care to minimize the risk of developing infections and gum disease.
• If you are undergoing chemotherapy, it is important that you have your platelet count evaluated before dental procedures to ensure that your immune, clotting, and healing functions are within acceptable limits.¹²
• Be sure to provide your dentist and physician(s) with each other's contact information in case they need to discuss your condition, oral health status, or medications you take.
• Ask your dentist to walk you through their office safety protocols and emergency procedures related to patients with cancer or bleeding disorders.
• Strictly follow your dentist's recovery plan, which may include medication and a soft-food diet for several days to ensure proper healing and avoid additional bleeding.

Take precautions

• If medically cleared to participate, people who have bleeding disorders should wear mouthguards when engaging in sports or activities to reduce the risk of excessive bleeding that can result from impact injuries. Talk to your dentist about preventing other types of trauma that can cause bleeding, such as grinding or clenching your teeth (bruxism), dental restorations, or orthodontic appliances.¹³

Medication

• Talk to your dentist or physician to better understand which medicines are safe for you to take. Medications such as aspirin or other pain relievers increase the risk of bleeding and may not be safe for some people to use before or after dental procedures. If you require pain management medication following a dental procedure and aspirin or nonsteroidal anti-inflammatories (NSAIDs) are not recommended, be sure to understand the potential implications of using opioid-based medications.
• Your physician may recommend medications to control bleeding or the risk of infection during invasive dental procedures such as tooth removal or periodontal surgery.¹⁴
• Some blood disorder medications may cause dry mouth, which reduces your ability to naturally wash away bacteria with saliva and lead to tooth decay and periodontal disease. Your dentist can suggest ways to increase your saliva flow or take additional steps to protect against tooth decay if this occurs.

Pregnancy

Women are at increased risk for "acquired hemophilia" during and after pregnancy. They are also at higher risk of anemia and vitamin deficiencies that can cause increased bleeding. If your dentist suggests treatment while you are pregnant or soon after childbirth, you may wish to discuss the risks and precautions for increased bleeding before undergoing any procedures.¹⁴

Children

When your child begins losing their baby teeth, slight bleeding is expected. If the bleeding does not stop on its own, apply pressure with wet gauze and call your child's dentist immediately. The dentist may recommend you consult with your child's physician or hematologist. If the bleeding cannot be stopped, it should be considered a medical emergency, and you should seek urgent care or call 911 for a faster response. If your child has a blood disorder, you should limit hot foods or straws when their baby teeth are loose or when adult (permanent) teeth begin to erupt since each can prevent blood clots from forming.¹⁵