Haemophilia Dental Management — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementHaemophilia Dental ManagementORE Part 1

A patient with severe haemophilia A (factor VIII activity <1%) requires conventional root canal treatment through the crown. The procedure will use rubber dam and buccal infiltration local anaesthesia; no inferior alveolar nerve block or lingual infiltration is planned. Which is the most appropriate classification and management?

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Correct answer: D — It is low bleeding risk and usually does not require factor replacement.

Explanation lettering: E = shown as A · A = shown as D · D = shown as E

A is correct. Conventional RCT through coronal access, using a rubber dam and buccal infiltration, is classified in UK haemophilia dental guidance as a low bleeding-risk procedure. It therefore does not usually require factor replacement solely because RCT is being performed, although the patient’s haemophilia team should be involved in planning. B and C incorrectly make factor cover routine for low-risk RCT. D is wrong because rubber dam clamp use is included within the low-risk RCT category. E is false: endodontic treatment is often preferable to extraction, which carries substantially greater bleeding risk. The key discriminator is the local anaesthetic technique: an inferior dental block or lingual infiltration is a higher-risk procedure and may require a haematology-directed haemostatic plan.

Reference: Oxford University Hospitals NHS Foundation Trust, “Dental care” (risk of bleeding for dental procedures), last reviewed 18 April 2024. https://www.ouh.nhs.uk/haematology/services/haemophilia/bleeding-disorders/dental-care/