The oral health of individuals with haemophilia: a mixed methods investigation

Abstract

Abstract Those living with haemophilia can experience the same oral diseases as those without haemophilia; however, their dental treatment is complicated by prolonged bleeding and the reluctance of general dentists to treat such individuals. With these potential additional barriers to dental care, it is hypothesised that those with haemophilia have worse oral health than the general population.

There has been little research on the oral health of individuals with haemophilia, and none at all conducted in New Zealand. Limited conclusions can be drawn about the oral health of this population because much of the evidence that is available is of poor quality and is heterogeneous in setting, participants and measurements. However, the evidence that is available suggests that PWH are likely to have worse oral health than the general population.

In order to help improve the provision of oral healthcare to individuals with haemophilia, the aims of this research were to: describe the oral health and oral health behaviours of those with haemophilia; compare these findings with estimates from the New Zealand population; explore the perceptions of oral health and its importance expressed by those with haemophilia; and, identify the barriers to oral health perceived by those with haemophilia.

An embedded, correlational, mixed methods design was used to research the oral health of those with haemophilia in New Zealand. All individuals with moderate or severe haemophilia, aged over the age of two, and residing in the Capital & Coast, Hutt Valley or Waiarapa District Health Board regions, were invited to participate in a clinical examination, questionnaire and semi-structured interview.

Clinical examinations and questionnaires were completed by 33 individuals, comprising 25 adults and 8 children, giving a participation rate of 86.8%. Qualitative and quantitative data were considered in tandem to provide a snap-shot of the oral health of those with haemophilia and these data were compared with data from the general New Zealand population. The questionnaire, clinical examination and interview data paint a picture of a sample who have experienced oral disease and have varied perceptions of oral health. They acknowledge the importance of oral health but do not always carry out behaviours conducive to oral health, with many different barriers being described.

Having high dental anxiety and living further away from the hospital were significantly associated with being edentulous. Those who were edentulous were likely to have had periodontal disease and the decision-making process to render these individuals edentulous is different to that for individuals without haemophilia. When compared with the New Zealand population, those with haemophilia have more mild periodontal disease, which may be related to a reluctance to perform oral hygiene, especially flossing.

Generally, those with haemophilia appear to have better oral health (less caries experience and lower prevalence of severe periodontal disease) but where there is poor oral health it has more of an impact on those with haemophilia. A model has been suggested to show how better oral health is related to access to hospital dentistry.