Extractions dentaires chez l’enfant présentant une maladie hémorragique constitutionnelle : protocole thérapeutique et résultats

Abstract

We report the results of our 10-year experience with a protocol of local hemostasis specifically elaborated for children with congenital bleeding disorders. Sixty-four dental extractions procedures were performed in 37 children. Local hemostasis was achieved with the CO2 laser at the site of extraction previously filled with regenerated oxidized cellulose. The site of extraction was then protected with thermomolded splint. The replacement therapy (hemostasis factor concentrates, platelet concentrates) was coordinated by the hematologist and restricted as much as possible. 160 decidual teeth and 23 permanent teeth were extracted. None of the children with minor bleeding deficiency received replacement therapy. Ten post-operative bleedings were recorded but none was considered severe. This protocol characterized by the use of CO2 laser for the hemostasis gave satisfaction in children. The rare and minor post-operative bleedings could be explained by multiple extractions, local infection and/or children's anxiety. This strategy requires a close cooperation between the stomatologist and the hematologist in order to determine the optimal therapeutic management.