Buccal infiltration may be a safe method for delivering anesthetic to patients with hemophilia undergoing dental procedures, according to a study published in Haemophilia.

A common method for administering anesthetic during dental procedures is using an inferior alveolar block, but this practice can lead to hematomas in patients with inherited bleeding disorders. Although buccal infiltration may be a safer alternative, evidence supporting this method is scarce. Moreover, it is unclear whether clinicians should have a certain amount of clinical experience in order to be qualified to perform this procedure.

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Researchers recruited 71 patients with mild (28%) and moderate or severe (72%) hemophilia who were scheduled to undergo a routine dental procedure while under local dental anesthesia. The type of procedure, injection site, type of anesthetic, and operator’s level of clinical experience were all recorded.

Patients received either 2% lignocaine with 1:80,000 adrenaline or 4% articaine with 1:100,000 adrenaline. After the anesthetic was administered, a cotton roll was used to apply pressure to the injection site for 30 seconds, and the site was examined periodically thereafter.

In total, 135 buccal infiltrations without additional factor replacement were performed. Clinicians with fewer than 3 years of experience conducted 59% of the infiltrations, and clinicians with 3 or more years of experience conducted the rest.

All but 2 infiltrations were successful; the 2 unsuccessful infiltrations were conducted with articaine. Success of anesthetic administration was not found to be associated with hemophilia severity (P =1.000), injection site (P =.102), anesthetic agent (P =.738), or level of clinical experience (P =.320).

There were 3 cases of postoperative bleeding after 30 seconds (2 in patients with mild hemophilia) and 5 cases of postoperative hematoma smaller than 2 mm after 2 minutes (2 in patients with mild hemophilia). All bleeding resolved within 2 minutes with pressure. No hematomas larger than 2 mm after 4 minutes were reported. There were no adverse events reported (defined as bleeding at the injection site or hematoma or jaw stiffness requiring factor replacement therapy).

The authors concluded that buccal infiltration performed by a clinician with any level of training in patients with hemophilia was safe. They noted that this finding was significant “because it means patients do not have to travel to a hemophilia center to be treated by specialist dentists for routine dental care.”

Reference

1.     Dougall A, Apperley O, Smith G, Madden L, Parkinson L, Daly B. Safety of buccal infiltration local anaesthesia for dental procedures [published online February 28, 2019]. Haemophilia. doi: 10.1111/hae.13695