Getting braces or other orthodontic devices such as a retainer is a rite of passage for millions of kids (and increasingly large numbers of adults as well). For some, braces are a cosmetic choice to straighten crooked teeth, but often they’re recommended to correct oral health issues such as an overbite or underbite, or a misaligned jaw, which could cause eating, drinking and speech problems.
People with bleeding disorders or parents of kids with bleeding disorders may have concerns about complications stemming from braces beyond the typical mouth soreness or general discomfort. The good news is placement of braces does not typically cause significant bleeding, and most issues after they’re in place are easily managed with the help of the orthodontist and your hemophilia treatment center (HTC) team.
Below are a few keys to ensuring your health while fixing your smile.
1. Find the right orthodontist
Hopefully by now you’ve found a dentist whom you’re comfortable with and who takes special care when treating you or your child. (If not, check out “Finding a Dentist Who Treats People with Bleeding Disorders.”) Since dentists are usually the ones who suggest orthodontia in the first place, ideally yours can recommend an orthodontist who is willing to coordinate with your HTC team or hematologist to minimize complications. If you have trouble finding an appropriate orthodontist, try asking your National Hemophilia Foundation chapter staff for help and seek recommendations from other community members at events or on message boards.
2. You may have options
The days when braces automatically meant sporting a mouthful of metal are thankfully gone. Steel brackets glued to teeth and connected with wires and rubber bands are still common, but other options are available. Removable clear aligners are one alternative growing in popularity, especially for adults. But be sure to discuss with your orthodontist what the most effective and safest treatment is for you.
3. Be prepared
Alan Kennell, an orthodontist in New Hampshire whose son has severe hemophilia A, recommends orthodontists check with a patient’s HTC “to discuss the basic plan for the patient and be aware of any specifics with regard to that patient.” Kennell notes that although getting and removing braces are fairly minimally invasive procedures, “I would recommend a factor infusion prior to these appointments, as cleaning excess adhesive off of the teeth can sometimes cause gingival irritation and or bleeding.” He says that routine orthodontic adjustments typically don’t require a prophy dose, “unless the orthodontist is planning a more involved procedure. It's good practice for the patient or parent to ask the orthodontist this prior to the next appointment, just to be safe.”
4. If you need teeth pulled
Sometimes extracting one or more teeth is recommended in preparation for installing braces. There are several reasons for this. Common ones are that a tooth is too damaged or unhealthy to support braces or that teeth are so crowded they need extra space in the mouth to properly realign. Tooth extraction is a surgical procedure, and as with any surgery precautions must be taken to minimize bleeding. Before an extraction, the general dentist or oral surgeon performing the procedure needs to communicate with the HTC so that a plan is in place for factor coverage before and after the extractions. Be sure you’re clear on what to do, and whom you should call if you experience complications.
5. Pay extra attention to oral hygiene
Kids especially (but adults too—you know who you are) can be lax about brushing their teeth and flossing. When wearing braces, dental plaque is more easily trapped on the teeth and gums, which in turn can cause inflammation and bleeding of the gums as well as increase the risk of cavities. People with bleeding disorders especially should do all they can to minimize these problems. Thus good dental habits, including careful brushing and flossing, are essential. If wires or bands are irritating the gums or cheeks, your orthodontist can show you how to temporarily apply dental wax to protect these areas.
6. Don’t worry too much
Getting braces or other orthodontic devices is a medical procedure, so a little worry is perhaps inevitable. But rest assured that the majority of people with bleeding disorders have few to no complications that are any different from anyone else with braces or other orthodontic treatments. Once again, the key to success is collaboration between you, the orthodontist, and the HTC or hematologist to ensure you’re getting the best care.