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Open Journal of Blood Diseases, 2013, 3, 13-14
doi:10.4236/ojbd.2013.31003 Published Online March 2013 (http://www.scirp.org/journal/ojbd) Dental Treatment with 30% Trichloroacetic Acid in a
Patient with Moderate Hemophilia A
Evelyn Gonzalez Delgado1,2, Gianluca Sottilotta2
1Dental Clinic, Fundación Hemo Hermanos Venezuela, Barinas, Venezuela; 2Foundation Hope and Life USA, Miami, USA. Email: dra.evelyn@foundationhopeandlifeusa.org Received December 28th, 2012; revised January 30th, 2013; accepted February 10th, 2013 ABSTRACT
We present the case of a 51-year-old moderate hemophiliac with gingival bleeding due to papillary inflammation and
adherence in the molar area 47. After dental diagnosis a calculus was removed and 30% trichloroacetic acid was placed
by a pressurized applicator for five seconds; the procedure was repeated until the bleeding stopped, then tranexamic
acid was placed by a gauze. The patient chewed the gauze for 30 minutes and was discharged after repeating the same
procedure for 30 minutes more. We observed how local treatment with trichloroacetic acid combined to tranexamic acid
placed on the hemorrhagic site was able to stop the bleeding.
Keywords: Hemophilia; Dental Treatment; 30% Trichloroacetic Acid; Clotting Factor
1. Introduction
acne scars and aging skin treatment [3,4]; at higher con- centrations it is used in condylomata acuminata, warts Hemophilia A is a congenital bleeding disorder caused and peeling. The TCA procoagulant effect can be locally by the mutation of gene on the X chromosome coding for used in dentistry for patients with bleeding disorders [5]. coagulation Factor VIII (FVIII). The normal FVIII range is 50% - 150%. The severity of hemophilia is related to the amount of the clotting factor in the blood. The classi- fication is made in severe (<1%), moderate (1% - 5%), A 51-year-old male patient with mild hemophilia A was and mild (5% - 40%). Patients with severe hemophilia admitted to the “Fundación Hemo Hermanos Venezuela” experience repeated and frequent spontaneous hemor- Dental Clinic. He presented gingival bleeding due to rhagic episodes, most commonly hemarthroses [1]. Pa- papillary inflammation and adherence in the molar area tients with moderate hemophilia mostly suffer from 47 because of presence of local irritants in the same traumatic bleeds only and generally do not experience lower right area. His hemorrhagic history was more se- spontaneous bleeding. The treatment involves the re- vere than his grade of hemophilia severity due to about placement of the deficient clotting factors by intravenous 10 - 12 hemarthroses per year treated “on-demand” with infusion to either control or prevent bleeding. Desmo- FVIII concentrates. Before dental treatment he was re- pressin, a synthetic derivative of the vasopressin, can ferred to the local hospital for the hematologic evaluation: increase factor VIII level in some patients with mild or the clinical examination confirmed the gingival hemor- moderate forms of hemophilia A. In the dental manage- rhage excluding other sites. Laboratory coagulation tests ment of hemophilic patients, it is important to manage evidenced absence of inhibitor to Factor VIII, prolonged the bleeding areas and also prevent any trauma during activated partial thromboplastin time (74 sec.) and was dental procedure [2]. Bleedings may be caused by mu- confirmed the moderate hemophilia (FVIII level 2%); the cosal irritation due to the continuous contact of dental outpatient dental treatment was authorized. At the dental calculus, or because of presence of plaque and its miner- clinic the calculus was removed immediately and 30% alization produced by gingival inflammation related to TCA was placed by a pressurized applicator for five food and bacterial deposition in the periodontal pockets. seconds. This procedure was repeated several times until In hemophiliac patients the excess of irritant agents can the bleeding stopped; then was placed tranexamic acid cause continuous bleedings. The 30% trichloroacetic acid 500 mg in vial directly to the site by a gauze. The patient (TCA) is an organic product with caustic action fre- chewed the gauze for 30 minutes and was discharged quently used in dermatology for various treatments as after repeating the same procedure for 30 minutes more. Copyright 2013 SciRes. OJBD
Dental Treatment with 30% Trichloroacetic Acid in a Patient with Moderate Hemophilia A 3. Discussion/Conclusion
The literature described many dental treatment protocols for hemophiliacs using oral antifibrinolytic agents, sys- REFERENCES
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