Dental management of people with complex or rare inherited bleeding disorders

Advances in haematological therapies for people with complex or rare inherited bleeding disorders (IBD) have resulted in them living longer, retaining their natural teeth with greater expectations of function and aesthetics. Dental management strategies need to evolve to meet these challenges. Utilising low level laser diode therapy to reduce pre-operative inflammation to reduce the intraoperative and postoperative burden on haemostasis is described in a case series of 12 patients. For these individuals who previously required further medical management to support haemostasis or experienced such prolonged haemorrhage sufficient to warrant hospital admission, haemostasis was achieved in the dental surgery such that they were able to return home with no further medical intervention or overnight stays. Global inequities in accessing novel treatments for complex or rare IBD necessitates a comprehensive understanding of the local haemostatic agents available to dentists and the most commonly used agents and techniques are described including the use of single tooth anaesthesia (STA). STA is a computerised delivery mechanism that allows routine dental procedures that would previously have required block injections needing factor replacement therapy to be undertaken safely and effectively with no additional haemostatic intervention. The challenges of inhibitors in oral surgery are explained and discussed although more research and evidence is required to establish new treatment protocols. The importance of establishing good dental health in the quality of life of people with complex or rare IBD is highlighted with respect to the dental specific impact that more novel therapies may have on people with IBD.

A cohort study and matched pair analysis evaluating the effects of the COVID-19 pandemic on access to dental care for people with inherited bleeding disorders

INTRODUCTION

Patients with inherited bleeding disorders (IBDs) can experience challenges in accessing dental care. The COVID-19 pandemic saw the cessation of routine dentistry in England. This study aims to highlight whether access to dental care for patients with IBDs was impacted by the pandemic, and whether the severity of their IBD impacts patients experience of dental care.

METHODS

Patients over the age of 18 with Haemophilia A and B, Von Willibrands (VWD), Bernard-Soulier syndrome (BSS) and Glanzmann's disease were recruited. One hundred and seventy-eight patients were called and invited to complete a questionnaire. Full cohort and matched pair analysis was performed.

RESULTS

Seventy participants completed the questionnaire (62 males, mean age 39.9), 26 had a mild IBD and 44 severe. Mild and severe patients were matched on IBD, gender, deprivation index and age. Thirty-one percent of patients tried to seek dental advice during the pandemic. Eighty-one percent of mild patients saw a dentist routinely prior to the pandemic, compared to 58% of severe patients. Doctors were more likely to discuss the importance of dental prevention with patients with severe IBDs (p = .0042).

CONCLUSION

Fewer patients with severe IBDs accessed regular dental care compared to their matched pair counterparts prior to the pandemic. This could indicate that access to care is more difficult for those with severe IBDs. Patients felt that oral health is relevant to their IBD. While doctors were more likely to discuss the importance of preventing dental disease with patients who have severe IBDs, the profession needs to ensure this translates into routine engagement.

Reduction in cycle time for a rapid polymerase chain reaction diagnostic test at the point of care

Background

Rapid testing facilitates safe and effective diagnosis, but the true speed of the process is the time from collection of a sample to delivery of an accurate and reliable test result - 'end-to-end' time. Transport, unpacking and relaying of information can extend this time considerably beyond the minimum laboratory turnaround times as stipulated by PCR testing protocols.

Aim/Objective

This study aimed to minimise time needed to ascertain SARS-CoV-2 status prior to treatment in a UK Dental Hospital using a novel, mobile, direct to polymerase chain reaction (PCR) workflow.

Methods

Process flow analysis and PDSA (Plan, Do, Study, Act) cycles for rapid continuous improvement were employed in a service improvement programme. Primerdesign™ q16 rapid PCR instruments and PROmate® COVID-19 direct assays were used for molecular testing.

Findings/Results

We showed a reduction in real-world end-to-end time for a diagnostic test from 240 min to 85 min (65% reduction) over a 4-week period.

Discussion

New rapid technologies have become available that reduce analytical time to under 90 min, but the real-world clinical implementation of the test requires a fully integrated workflow from clinic to reporting.

Public involvement in research: exploring periodontal and peri-implant health and disease in partnership with Perio@RLH patient forum members

Patients, carers and the public form an important partnership with the research community. By working alongside researchers, patients make a valuable contribution to all parts of the research cycle. This paper provides an opinion regarding public involvement in periodontal and peri-implant research and summarises the key points derived from a focus group that explored the topic of research in the conditions of periodontal and peri-implant health and disease. The partnership comprised forum members from the Royal London Hospital periodontics patient group (Perio@RLH) and a multidisciplinary team of researchers and clinicians.

Access to primary dental care for patients with inherited bleeding disorders

Patients with inherited bleeding disorders (IBD) can face difficulty in accessing primary dental care either due to disease-specific or patient-related barriers. This can lead to poor oral health and increase the need for more invasive dental treatment. This study aimed to highlight actual and perceived barriers that IBD patients from the East London area were experiencing. It also gives an overview of the experience history of the General Dental Practitioners (GDPs) treating these patients. Information was gathered via pre-designed surveys as part of a service development audit. A total of 105 anonymous patient surveys and 50 GDP surveys were completed between December 2010 and July 2011. The patient survey highlighted more patients to be affected by patient-related than disease-specific barriers to access dental care. The GDP survey identified that just under half of GDPs questioned were not confident in the dental management of patients with bleeding disorders. Identifying misconceptions and barriers to access primary dental care will enable further development of our shared-care approach between General Dental Services, Hospital or Community Dental Services and Haemophilia Centre, optimizing regular preventative advice and follow ups to prevent dental disease and invasive dental treatment requiring haemostatic treatment.