Oral Health Policy and Recommendations for Children with Hemophilia in Bulgaria

Abstract

BACKGROUND: Hemophilia is the most common inherited coagulopathy, but its diagnosis and treatment are still a challenge for healthcare professionals. Collaborative efforts between National bleeding disorder agencies, World Federation of Hemophilia, Ministries of Health, educational institutions, and non-governmental organizations aim to improve access to care and the quality of life of people with coagulopathies AIM: The aim of this study was to analyze and critically evaluate the oral health policy for children with hemophilia in Bulgaria. MATERIALS AND METHODS: A sociological survey is conducted among dentists in Bulgaria during the period 2019 - 2020 about their attitude toward the oral health policy regarding children with hemophilia in Bulgaria. The oral health legislation of Bulgaria and international guidelines for dental care of people with hemophilia is critically evaluated. Data is revised and synthetized for implementation in the Bulgarian health policy. RESULTS: In 2013, the first European guidelines for the certification of Hemophilia Centers are published, which is the only document accrediting centers for rare diseases. According to the recommendations of the World Federation of Hemophilia, dental and medical care for people with hemophilia should be provided in hemophilia treatment centers. According to the latest guidelines from 2020, dental care for people with hemophilia should be provided by every dentist, regardless of their specialty. Most of the dentists (n = 88; 84.62 ± 3.54%) would be more confident in treating a patient with hemophilia in their practice if they are part of an organized team. In need of a consultation with another doctor, dentists prefer to refer the case to a specialist clinical hematologist (n = 74; 71.15 ± 4.44%), pediatric oncohematologist (n = 60; 57.69 ± 4.84%), or oral surgeon (n = 35; 33.65 ± 4.63%). DISCUSSION: Improvement can be achieved through programs for management of specific dental conditions, targeted at rare disease groups, and successfully implemented in health policy at the local level. CONCLUSION: Potential new policies may offer more dental treatment options for people with hemophilia. In-depth clinical and sociological studies are needed to determine the optimal effect in the current state and situation.