ORIGINAL RESEARCH |
https://doi.org/10.5005/jp-journals-10005-2523 |
State of Dental Health and Management needs of Young Hemophilic Patients: A Case-control Study
1Department of Pedodontics & Preventive Dentistry, Dental College, RIMS, Ranchi, Jharkhand, India
2Department of Oral & Maxillofacial Surgery & Oral Implantology, Dental College, RIMS, Ranchi, Jharkhand, India
3Department of Orthodontics & Dento-facial Orthopaedics, Dental College, RIMS, Ranchi, Jharkhand, India
4Faculty of Oral & Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
5Department of Prosthodontics, Dental College, RIMS, Ranchi, Jharkhand, India
6Department of Pedodontics and Preventive Dentistry, Vananchal Dental College & Hospital, Garhwa, Jharkhand, India
7Department of Oral Medicine & Radiology, People’s College of Dental Science and Research Center, People’s University, Bhopal, Madhya Pradesh, India
Corresponding Author: Ajoy K Shahi, Department of Oral & Maxillofacial Surgery & Oral Implantology, Dental College, RIMS, Ranchi, Jharkhand, India, Phone: + 91 9955361090, e-mail: drajoyshahi@gmail.com
ABSTRACT
Background: In particular, when it comes to systemic diseases like hemophilia, good dental health is crucial to a person’s overall health and wellness. Through the means of this study, we aim to assess the prevalence of various dental anomalies in children suffering from hemophilia in comparison to healthy children and assess their treatment needs.
Materials and methods: This was a descriptive, case-control study with 400 subjects, 200 each in the study (hemophilic) and control (nonhemophilic) groups. The subjects’ ages ranged from 5 to 15 years. Utilizing the oral hygiene index-simplified (OHI-S), the state of oral hygiene was documented (OHI-S). Using decaying extracted filled tooth (DEFT) and decayed, missing, and filled tooth (DMFT) for the primary and permanent dentition, respectively, teeth afflicted by dental caries and teeth restored/extracted as a result of dental caries were assessed. Statistical Package for the Social Sciences (SPSS) software (version 27.0) was used for statistical analysis.
Results: Hemophilic people had a considerably greater incidence of dental caries. Furthermore, even though their DMFT/DEFT and OHI-S scores were barely poorer than those of healthy people, children with hemophilia had a significantly larger percentage of dental treatment needs across all age categories than the other group.
Conclusion: The percentage of hemophilic children who needed dental treatment across different age groups was significantly higher than the other group, which supports our observations that the dental health status of hemophilic children was poor and treatment requirement was high among them as well. This is true even though the DMFT/DEFT scores and OHI-S scores in hemophilic children were only slightly worse than in healthy individuals.
How to cite this article: Sharma S, Shahi AK, Chandra S, et al. State of Dental Health and Management needs of Young Hemophilic Patients: A Case-control Study. Int J Clin Pediatr Dent 2023;16(2):380–387.
Source of support: Nil
Conflict of interest: None
Keywords: Caries, Dental health care, Hemophilia, Oral health, Oral hygiene
INTRODUCTION
One of the most difficult medical situations for medical professionals to treat is bleeding disorders.1 The most prevalent disease among them is hemophilia. Hemophilia is an X-linked genetic condition that is brought on by a lack of clotting factors factor VIII and factor IX. Depending on the plasma levels of the coagulant, it may be severe, moderate, or mild.2 The World Health Organization (WHO) claims that oral health is a crucial sign of overall health, happiness, and quality of life. Globally, 3.5 billion people are predicted to be affected by oral disorders, according to the Global Burden of Disease Study 2017.3 The majority of studies favor tooth loss as one of the key indicators of oral health and as a variable.4 The most prevalent oral diseases and the leading causes (85–90%) of tooth extraction are dental caries and periodontal disease.5-7
Children with hemophilia must be regarded as a separate category of patients due to the multiple effects it has on the patient’s overall health.8 In this population of patients, bleeding most frequently occurs in the oral cavity, which is a highly vascular location. This is especially true after tooth extraction, the exfoliation of deciduous teeth, or trauma to the oral mucosa.9,10 More hemophiliacs than the control groups are affected by periodontal inflammatory illnesses, including gingivitis and periodontitis. The changes to the oral mucosa, especially the inflammatory states, might cause irreparable harm to the periodontium, including harm to alloplastic structures that were implanted to help patients recover.11,12
Due to the potential consequences of trauma or injury to the skin or mucous membranes and the resulting danger of bleeding, patients with hemophilia experience a psychological state of terror. Children with hemophilia are more prone than their healthy classmates to experience psychological issues.13 In order to prevent bleeding episodes, hemophilic patients are reportedly scared to perform daily preventative measures in the right way, including brushing or flossing. It is also possible that hereditary coagulation problems are risk factors for oral diseases.14 Due to ignorance, young patients, in particular, are more prone to bleeding.
Many hemophiliac patients have also encountered general dental practices that would not treat them. As a result, people could put off visiting the dentist until they require severe care. Similar to other patients, members in this category require routine dental treatment, and effective preventive practices, in particular, are crucial.15
Due to a lack of understanding about oral health care and a lack of awareness about developments in bleeding management, hemophilic patients and dental professionals have an excessive amount of dread of one another. Early intervention and proper counseling regarding oral hygiene practices are essential for minimizing difficulties in this population of individuals. The majority of minimally invasive dental procedures do not require factor replacement. The coordination of hematologists with patients with hemophilia undergoing extractions or subgingival periodontal treatment is necessary.
NEED FOR THE STUDY
Numerous studies have reported on surgical and periodontal management of hemophilic patients.16-18 However, studies describing oral hygiene status, dental caries, and treatment needs of hemophilic children are still lacking. Moreover, the results of these studies are highly conflicting. Data obtained from some of these studies indicate alarming conditions of poor oral health status in hemophilic patients and suggested interventional strategies to combat oral diseases in this special group.19-22
Some studies, on the contrary, reported superior oral hygiene status in hemophiliacs as there was a significant influence of parental tooth brushing habits on children with hemophilia since the disease is hereditary in nature.23-25 In a few studies, there was no significant difference in oral hygiene levels in hemophilic and healthy individuals.26,27 The data on oral health status and treatment need in the young hemophilic patient is not available for Jharkhand and Eastern India. The data gathered on the oral hygiene index and dental caries prevalence can be helpful in determining whether bleeding disorders are risk factors for dental caries and poor oral hygiene status or not. It will also help the dentist in establishing preventive measures and effective dental management of patients with hemophilia. So, this study was conducted to compare oral hygiene status and dental caries status of hemophilic male children with that of nonhemophilic male children of same age group. Extensive research has discussed how hemophiliac patients are managed surgically and periodontally.16-18 However, there is currently a paucity of publications detailing dental caries, oral hygiene conditions, and treatment requirements of hemophilic youngsters. The outcomes of these investigations are also incredibly contradictory. Data from a few of these studies point to concerning oral health issues in people with hemophilia and provide interventional tactics to treat oral disorders in this unique population.19-22
Some studies, however, have found that hemophiliacs have better dental hygiene than the general population since the disease is inherited, and parental tooth-brushing habits have a substantial impact on their children’s oral cleanliness.23-25 Few investigations found no discernible difference in oral hygiene practices between hemophiliacs and healthy people.26,27 Eastern India and Jharkhand do not have statistics on the state of oral health and the need for treatment in young hemophiliac patients. It is possible to determine whether or not bleeding problems are risk factors for dental caries and poor oral hygiene status using the data collected on the oral hygiene index and dental caries prevalence. It will aid dentists in devising preventive strategies and efficient dental management of patients with hemophilia. Therefore, this study was carried out to compare and assess the oral health status of young hemophiliac patients in Ranchi, Jharkhand, India, with respect to healthy individuals, that is, nonhemophilic children.
MATERIALS AND METHODS
Study Design
This descriptive case-control study was conducted for a period of 1 year on young male individuals’ age ranging between 5 and 15 years divided into case (hemophilic) and control (nonhemophilic) groups.
This investigation of ours was carried out in Dental College, RIMS, Ranchi, Jharkhand, India and was registered with the Institutional Ethical Committee (IEC) of Dental College, RIMS, Ranchi, Jharkhand, India and obtained the IEC number—277/IEC/RIMS–23/06/21.
Eligible hemophilic children were selected randomly from a list generously provided by the Ranchi chapter of the Hemophilia Society, with whom this study was carried out as a collaborative effort. Proper age eligibility assessments, along with the relevant inclusion and exclusion criteria, were observed at the time of sampling.
Study Population
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Case group: Young male individuals suffering from hemophilia and registered with the Hemophilia Society, Ranchi Chapter.
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Control group: Young, healthy male individuals matched with the case group with respect to age and gender.
Sample Size Calculation
A total of 400 individuals were deemed to be a suitable sample size for our study. This sample size was determined according to the Cochran formula shown below:
Sample size = Z2 P (1−P)/ D2
where, N = minimum sample size, Z = coefficient of Z statistics obtained from standard normal distribution, P = Proportion (in %) Q = 1−P, and D = sample error tolerated (in %)
Hence, using a prevalence rate of 8.6%28,29 at a confidence limit of 95% (D = 5%) and Z of 3.55, the minimum sample size (N) is calculated as
N = 3.552 × 8.6 (100−8.6)/52
N = 396.24
As a result, the study’s minimum sample size (N) was to be kept around 400 male individuals, which should have sufficed the needs of our study.
Inclusion Criterion
Young male individuals in the age group of 5–15 years suffering from hemophilia for the study/case group and healthy children who were willing to participate through signed informed consent for the control group.
Exclusion Criterion
The study did not include any subjects with severe crowding, other hematological problems, or systemic diseases. People who refused to participate or who did not sign informed consent were also excused from the investigation. The examination was carried out by a single examiner. OHI-S index, DMFT/DEFT index, and treatment need index recorded on standardized pro forma.
Statistical Analysis and Variability
Microsoft Excel was used to create the template, while SPSS was used to analyze the data (version 27.0). Depending on the data’s normality, appropriate statistical parametric and non-parametric tests were used. Utilizing chi-squared testing, the prevalence of dental caries, oral hygiene status, gingival health, and data on prior dental history and oral hygiene practices were presented as proportions (Tables 1 –5). When comparing dental caries experience and OHI-S between hemophilia patient and control groups, an independent-samples t-test or Mann–Whitney U test was used, depending on whether the data were parametric or nonparametric, as evident by the results shown in Tables 5A and B and 6A and B.
| Variable analyzed | Variable characteristic | Frequency | Percentage |
|---|---|---|---|
| Age group | 5–7 years | 124 | 31% |
| 8–11 years | 132 | 33% | |
| 12–15 years | 144 | 36% | |
| Total | 400 | 100% | |
| Demographical location | Urban | 89 | 22% |
| Periurban | 157 | 39% | |
| Rural | 154 | 39% | |
| Total | 400 | 100% | |
| Consanguineous marriage | Yes | 217 | 54% |
| No | 183 | 46% | |
| Total | 400 | 100% | |
| Frequency of tooth brushing | Never | 33 | 8% |
| Once a day | 163 | 41% | |
| Twice a day | 116 | 29% | |
| Several times a week | 88 | 22% | |
| Total | 400 | 100% | |
| Frequency of visits to a dentist in the past 12 months | Once | 115 | 29% |
| Twice | 86 | 22% | |
| Thrice | 49 | 12% | |
| No visit | 71 | 18% | |
| Never visited | 79 | 20% | |
| Total | 400 | 100% |
| Variable analyzed | Variable characteristic | Frequency | Percentage |
|---|---|---|---|
| Age group | 5–7 years | 45 | 23% |
| 8–11 years | 69 | 35% | |
| 12–15 years | 86 | 43% | |
| Total | 200 | 100% | |
| Demographical location | Urban | 43 | 22% |
| Periurban | 88 | 44% | |
| Rural | 69 | 35% | |
| Total | 200 | 100% | |
| Consanguineous marriage | Yes | 143 | 72% |
| No | 57 | 29% | |
| Total | 200 | 100% | |
| Type of hemophilia | VIII | 168 | 84% |
| IX | 26 | 13% | |
| Others | 6 | 3% | |
| Total | 200 | 100% | |
| Severity level | Mild | 8 | 4% |
| Moderate | 31 | 16% | |
| Severe | 161 | 81% | |
| Total | 200 | 100% | |
| Presence of hemophilic family member | Yes | 29 | 15% |
| No | 92 | 46% | |
| Not available | 79 | 40% | |
| Total | 200 | 100% | |
| History of spontaneous oral bleeding | Yes | 124 | 62% |
| No | 76 | 38% | |
| Total | 200 | 100% | |
| History of bleeding during brushing | Yes | 129 | 65% |
| No | 71 | 36% | |
| Total | 200 | 100% |
| Type of group | Variable analyzed | Variable characteristic | Frequency | Mean | Standard deviation | Standard error |
|---|---|---|---|---|---|---|
| Case group (hemophiliac) | DMFT + DEFT | 5–7 years | 45 | 4.69 | 2.343 | 0.511 |
| 8–11 years | 69 | 3.64 | 1.743 | 0.390 | ||
| 12–15 years | 86 | 3.45 | 1.370 | 0.314 | ||
| Total | 200 | 3.93 | 1.972 | 0.255 | ||
| OHI-S | 5–7 years | 45 | 1.23 | 0.763 | 0.167 | |
| 8–11 years | 69 | 1.39 | 0.586 | 0.131 | ||
| 12–15 years | 86 | 1.91 | 0.872 | 0.200 | ||
| Total | 200 | 1.51 | 0.776 | 0.100 | ||
| Control group (nonhemophilic) | DMFT + DEFT | 5–7 years | 58 | 4.32 | 2.302 | 0.523 |
| 8-11 years | 63 | 3.56 | 1.723 | 0.345 | ||
| 12–15 years | 79 | 3.29 | 1.356 | 0.298 | ||
| Total | 200 | 3.72 | 1.794 | 0.389 | ||
| OHI-S | 5–7 years | 58 | 1.19 | 0.755 | 0.161 | |
| 8–11 years | 63 | 1.88 | 0.581 | 0.128 | ||
| 12–15 years | 79 | 1.89 | 0.863 | 0.213 | ||
| Total | 200 | 1.65 | 0.733 | 0.167 |
| Type of group | Variable analyzed in terms of treatment needs | Age group | ||
|---|---|---|---|---|
| 5–7 years | 8–11 years | 12–15 years | ||
| Case group (hemophiliac) | Children don’t Require Treatment | 8 (18%) | 12 (17%) | 11 (13%) |
| Preventive Care | 33 (73%) | 44 (64%) | 43 (50%) | |
| Fissure Sealant | 15 (33%) | 14 (19%) | 21 (24%) | |
| One Surface Filling | 21 (45%) | 30 (44%) | 35 (41%) | |
| Two or more Surface Filling | 15 (33%) | 21 (40%) | 29 (33%) | |
| Crown | 32 (70%) | 38 (54%) | 43 (50%) | |
| Pulp Care | 29 (33%) | 34 (49%) | 46 (53%) | |
| Extraction | 33 (72%) | 21 (44%) | 39 (46%) | |
| Control group (nonhemophilic) | Children don’t Require Treatment | 15 (26%) | 14 (22%) | 19 (24%) |
| Preventive Care | 27 (47%) | 36 (58%) | 40 (51%) | |
| Fissure Sealant | 23 (42%) | 19 (32%) | 46 (59%) | |
| One Surface Filling | 28 (51%) | 21 (34%) | 53 (68%) | |
| Two or more Surface Filling | 23 (42%) | 35 (55%) | 17 (22%) | |
| Crown | 31 (56%) | 27 (43%) | 32 (41%) | |
| Pulp Care | 16 (29%) | 19 (32%) | 35 (44%) | |
| Extraction | 23 (42%) | 21 (34%) | 40 (51%) | |
| Variable analyzed | DMFT score | N | Mean within the groups | Standard deviation | Standard error mean |
|---|---|---|---|---|---|
| The mean value of the two groups | 1 | 200 | 3.9267 | 0.66786 | 0.38559 |
| 2 | 200 | 3.7233 | 0.53407 | 0.30835 |
| Variables analyzed | Levene’s test for equality of variances | t-test for equality of means | |||||
|---|---|---|---|---|---|---|---|
| F | Significance | t | Degrees of freedom | Significance (two-tailed) | Mean difference | ||
| Type of variance assumed | Equal variances assumed | 0.351 | 0.585 | 0.412 | 4 | 0.702 | 0.20333 |
| Equal variances not assumed | 0.412 | 3.816 | 0.703 | 0.20333 | |||
| Variable analyzed | OHI-S scores | N | Mean within the groups | Standard deviation | Standard error mean |
|---|---|---|---|---|---|
| Mean value of the two groups | 1 | 200 | 1.51 | 0.35553 | 0.20526 |
| 2 | 200 | 1.6533 | 0.40129 | 0.23168 |
| Variables analyzed | Levene’s test for equality of variances | t-test for equality of means | ||||||
|---|---|---|---|---|---|---|---|---|
| F | Significance | t | Degrees of freedom | Significance (two-tailed) | Mean difference | Standard error difference | ||
| The type of variance assumed | Equal variances assumed | 0.142 | 0.725 | −0.463 | 4 | 0.667 | −0.14333 | 0.30953 |
| Equal variances not assumed | −0.463 | 3.943 | 0.668 | −0.14333 | 0.30953 | |||
The significance value, that is, the p-value > 0.5 in this case, which means it is not statistically significant and that the homogeneity assumption of the variance (OHI-S in this case) is met
RESULTS
Table 1, as given below, displays all the demographic characteristics of the participants enrolled in our study, such as age group, demographic location, frequency of dental checkups, and oral habits. The number of people in 5–7 years age group was 94, 8–11 years were 102, and 12–15 years 104 of the 300 individuals, 86 had once visited a dentist, 65 had twice, 42 thrice, and 48 had never visited. Around 81 individuals were from the urban area, 111 were from the periurban area, and 108 were from the rural domain.
Table 2, as shown below, displays all the demographic characteristics of the participants enrolled in our study, such as age group, their demographic location, frequency of dental checkups, and oral habits, as shown in Table 1, but only for the hemophiliac individuals that were a part of our study. The number of people in 5–7 years age group was 39, 8–11 years were 48, and 12–15 years 63 of the 150 individuals, 81 had a history of spontaneous oral bleeding, whereas 94 had a history of bleeding during brushing. A total of 29 individuals were from the urban areas, 65 from periurban areas, and 56 from the rural domains.
In the hemophiliac group, DMFT + DEFT frequency for 5–7 years was 45; for 8–11 years was 69 and for 12–15 years was 86. The OHI-S frequency for the 3 age groups was the same as DMFT/DEFT scores.
In the nonhemophilic group, DMFT + DEFT frequency for 5–7 years was 58; for 8–11 years was 63 and for 12–15 years was 79. The OHI-S frequency for the 3 age groups was the same as DMFT/DEFT scores.
In the case of the hemophiliac group, for the category “Children don’t Require Treatment,” the frequency was 8 for 5–7 years old, 12 for 8–11 years old, and 11 for 12–15 years old. For the “Preventive Care” category, the frequency was 33 for 5–7 years old, 44 for 8–11 years old, and 43 for 12–15 years old. For the “Fissure Sealant” category, the frequency was 15 for 5–7 years old, 14 for 8–11 years old, and 21 for 12–15 years old. For the “One Surface Filling” category, the frequency was 21 for 5–7 years old, 30 for 8–11 years old, and 35 for 12–15 years old. For the “Two or more Surface Filling” category, the frequency was 15 for 5–7 years old, 21 for 8–11 years old, and 29 for 12–15 years old. For the “Crown” category, the frequency was 32 for 5–7 years old, 38 for 8–11 years old, and 43 for 12–15 years old. For the “Pulp Care” category, the frequency was 29 for 5–7 years old, 34 for 8–11 years old, and 46 for 12–15 years old. For the “Extraction” category, the frequency was 33 for 5–7 years old, 21 for 8–11 years old, and 39 for 12–15 years old.
In the case of the hemophiliac group, for the category “Children don’t Require Treatment,” the frequency was 15 for 5–7 years old, 14 for 8–11 years old, and 19 for 12–15 years old. For “Preventive Care” category, the frequency was 27 for 5–7 years old, 36 for 8–11 years old, and 40 for 12–15 years old. For the “Fissure Sealant” category, the frequency was 23 for 5–7 years old, 19 for 8–11 years old, and 46 for 12–15 years old. For the “One Surface Filling” category, the frequency was 28 for 5–7 years old, 21 for 8–11 years old, and 53 for 12–15 years old. For the “Two or more Surface Filling” category, the frequency was 23 for 5–7 years old, 35 for 8–11 years old, and 17 for 12–15 years old. For the “Crown” category, the frequency was 31 for 5–7 years old, 27 for 8–11 years old, and 32 for 12–15 years old. For the “Pulp Care” category, the frequency was 16 for 5–7 years old, 19 for 8–11 years old, and 35 for 12–15 years old. For the “Extraction” category, the frequency was 23 for 5–7 years old, 21 for 8–11 years old, and 40 for 12–15 years old.
Tables 5A and 5B represent the group statistics for DMFT/DEFT indices and the independent t-test results obtained on the basis of the findings as mentioned in Table 3 (where 1 refers to the case group consisting of hemophiliacs and 2 refers to the control group consisting of nonhemophiliacs).
The significance value, that is, the p-value > 0.5 in this case, which means it is not statistically significant and that the homogeneity assumption of the variance (DMFT/DEFT in this case) is met.
Tables 6A and 6B represent the group statistics for OHI-S scores and the independent t-test results obtained on the basis of the findings as mentioned in Table 3 (where 1 refers to the case group consisting of hemophiliacs and 2 refers to the control group consisting of nonhemophiliacs).
DISCUSSION
The population’s share of people with congenital hemorrhagic diatheses is quite minimal. Due to the fact that the majority of dentists lack experience treating oral problems in such people, treating these patients can be difficult for them.30 As a result, hemophiliacs frequently have trouble getting basic dental treatment. The majority of hemophiliac patients can be treated in a private dentist’s office, though.31 The possibility that moderate hemophilia may not be discovered until puberty if surgery, serious injury, or teeth extractions are avoided must be taken into account. Thus, a patient with hemophilia can occasionally receive the first diagnosis from a dentist. Patients who are hemophiliacs are a special population since standard dental care can be fatal for them.
Research shows that after experiencing severe mouth bleeding, 14% of all hemophilia patients and 30% of people with moderate types received their initial diagnoses.32 Oral hemorrhage most frequently impacted the tongue and labial frenulum. Episodes of spontaneous bleeding can occur in patients during tooth brushing, food abrasion, or periodontal disease due to the profusion of enlarged capillaries on the surface of the weaker portions of the gingiva. Patients with congenital bleeding problems should place a high premium on maintaining good dental health.25 However, hemophiliacs could require many trips to complete this task. Hematologists and dentists working together yield successful dental care for hemophilia patients.33 For routine checkups and dental treatment, raising the factor level is typically not essential, but adequate coverage is required prior to and maybe after more involved operations like deep cleaning or the removal of heavy plaque/tartar.34,35 However, there are specific instances where only community dental clinics or hospitals can provide patients with safe dental care [cervical dentin sensitivity (CDS)]. Only surgeries, extractions, and any dental procedures requiring inferior alveolar block anesthesia and lingual infiltration anesthesia require a referral to a hospital or CDS, according to “guidelines for dental treatment of patients with inherited bleeding disorders” (The World Federation of Hemophilia 2006).36 Periodontal surgery must always be considered a high-risk procedure with a significant risk of blood loss in patients with bleeding issues. The difficulty of hemostasis can be greater than that of a simple extraction.16
The current study indicates that, with regard to the case group, the mean DEFT and DMFT of 4.69 is in the age range of 5–7 years, 3.64 in that of 8–11 years, and 3.45 in that of 12–15 years. According to the WHO, the mean DMFT at age 12 should not be >3.7.9
In a study, Boyd and Kinirons37 discovered that primary dentition dental caries was somewhat more common in children with hemophilia than in controls. The DMFT and DEFT of children with hemophilia were also significantly higher than those of nonhemophilic children, according to Kabil et al.’s study in Egypt.21
Our results are consistent with those of Sonbol et al. study25, which discovered that significantly more children with severe hemophilia l had no dental caries than did controls. The hemophilia group’s DMFS and DMFT were somewhat higher than those of the controls. This could be a result of the fact that the dentist’s office was situated adjacent to the outpatient hematology consulting room, where patients received dental care, and the dental service was considered to be a crucial part of the hematology visit.
The case groups for the current investigation scored poorly on the oral hygiene index simplified—12–15 years (1.91), 8–11 years (1.39), and 5–7 years (1.23). These findings were in line with a Polish study that discovered hemophiliac children had lower oral hygiene than control children.38
Our results contrast with those of a study by Zaliuniene et al.,23 which revealed that overall results were better in deciduous dentitions, that is, children with hemophilia experienced less overall caries and required fewer dental treatments than their healthy peers. A substantial difference was discovered when the permanent dentitions of the hemophiliacs and controls were compared.
The mean DMFT score in the current study was 4.69 in the age range of 5–7 years, 3.64 in that of 8–11 years, and 3.45 in that of 12–15 years in the hemophiliacs, in contrast to the study conducted by Evangelista,10 where the DMFT score was 0.9. This variation could be explained by the early identification of dental caries. The current investigation’s findings did not agree with those of a study by Rodrigues et al.,39 which discovered that the mean DEFT was 2.00 and that the study’s reported high-need groups were hemophiliac children between the ages of 5–7 and 54% and 8–11. With the exception of crowns, which tend to become less necessary as individuals age, the most plausible explanation is that as people age, the prevalence of caries progression increases, and so do their treatment demands. Children aged 5–7 require more crowns than children aged 8–11 because caries spreads more quickly in mixed dentition.
In the current study, when looking at the hemophilic individuals in the 5-year-old age category, 73% of the participants required preventative treatment, 33% required a fissure sealant, extractions of 72%, and pulp care 33%. The results of this investigation and the study by Sudhanshu et al. were in agreement.9
But the most noticeable statistic to come out of our investigation was the percentage of children that required dental treatment. Around 82% of the hemophilic individuals aged between 5 and 7 years, 83% of them in 8–11 years, and 87% of hemophiliacs in the 12–15 years age category were observed to require oral treatment/prophylaxis of some variety or more. The treatment protocols needed were the ones listed in Table 4, as well as others that were beyond the scope of our investigation. In comparison to the case group, the control group consisting of nonhemophilic individuals recorded 74, 78, and 76% of children in the 5–7, 8–11, and 12–15 years categories, respectively, were found to require oral treatment strategy of one or more sort. There was 8, 5, and 11% difference across the three age groups, respectively, between the case and control groups with respect to this parameter. This, along with the differences across other management protocols mentioned in Table 4 between the two groups, revealed that a higher percentage of hemophilic children required dental treatment in comparison to their healthy counterparts—an observation confirmed by two studies8,19 done using similar methodological approaches as ours, though it has to be mentioned that the studies possessed smaller sample sizes compared to ours.
In terms of limitations, we believe that the involvement of more age groups would have led to better results, and the subsequent outcomes might have led to a better understanding of the correlation between hemophilia and the incidence of poor oral health among its sufferers. We believe there is a dearth of epidemiological studies on the state of oral health in hemophiliac patients. More thorough, extensive studies with varied methodological approaches are needed to completely understand the dental health of children with hemophilia and their plight.
CONCLUSION
Although the DMFT/DEFT scores and OHI-S scores are only noticeably worse in hemophilic children in comparison to the healthy individuals, the percentage of hemophilic children that require dental treatment across various age groups was significantly worse than the other group, which supports our observations that dental health status of hemophilic children was poor and treatment requirement was high among them as well. This decline in all aspects of oral health would, according to the author’s opinion, would worsen as the sufferers would grow older, hence we believe dental professionals need to assess hemophilic individuals with much more caution. Better communication between hematologists, hospital dental specialists, and those in regular dentistry practices may be a key first step in creating effective dental management of patients with hemophilia.
ORCID
Swati Sharma https://orcid.org/0000-0001-6302-4542
Ajoy K Shahi https://orcid.org/0000-0002-3120-8037
ACKNOWLEDGMENTS
We thank Haemophilia Society, Ranchi and Hemophilia Federation (India) for their support and help.
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