title: Risk-based management of dental procedures in patients with inherited bleeding disorders: Development of a Dental Bleeding Risk Assessment and Treatment Tool (DeBRATT).
abstract: BACKGROUND
  Successful outcomes in dental management for patients with inherited bleeding disorders require close collaboration between haematology teams and dentists.
  
  
  OBJECTIVE
  To review outcomes of an interdisciplinary pathway for dental procedures by assessing adequacy and appropriateness of haemostatic management.
  
  
  METHODS
  Two hundred dental procedures in 30 patients with inherited bleeding disorders were included. A Dental Bleeding Risk Assessment and Treatment Tool (DeBRATT) was developed to identify four categories of bleeding risk (no risk, low, moderate and high risk of bleeding) in relation to the severity of the bleeding disorder and the invasiveness of dental procedure. The adequacy and appropriateness of haemostatic therapy provided in relation to the bleeding risk was assessed with reference to the published literature. Treatment was classified as appropriate, over or under-treatment. Bleeding complication was the primary outcome.
  
  
  RESULTS
  A high level of dental disease was noted, with 83% of patients having at least one decayed tooth and 46.7% having chronic gum disease. A total of 59.1% of the dental procedures in patients with mild bleeding disorders were over-treated (n = 65/110) and 8.9% in patients with severe disorders had an extended duration of treatment (n = 7/79). One bleeding complication was observed in a patient with Von Willebrand's disease and severe thrombocytopenia. All other procedures (99.5%) were uneventful.
  
  
  CONCLUSIONS
  DeBRATT enables a risk-based approach for the management of dental procedures in patients with inherited bleeding disorders. The tool facilitates a comprehensive evaluation of bleeding risk with the potential to minimize unnecessary treatment and aid interdisciplinary communication among different clinical teams.
authors.affiliation: Department of Restorative Dentistry, Eastman Dental Hospital, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Rasaratnam
authors.affiliation: Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Chowdary
authors.affiliation: Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Pollard
authors.affiliation: Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Subel
authors.affiliation: Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Harrington
authors.affiliation: Department of Restorative Dentistry, Eastman Dental Hospital, London, UK.
authors.forename: U R
authors.initials: UR
authors.lastname: Darbar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003729:Dental Care / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D018570:Risk Assessment; D055815:Young Adult; D014842:von Willebrand Diseases / Q000150:complications*
keywords: bleeding assessment tool; dental disease; haemophilia; inherited bleeding disorders; risk assessment tool