الفهرس 
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Abstract
Summary
Many congenital and acquired bleeding disorders in children have a common symptom which is oral bleeding. Although knowledge of hemostasis and management of bleeding disorders is widely advanced, neglecting oral hygiene remains a big concern among patients with bleeding disorders5. As a result, there is usually an increase in the incidence of dental caries, gingivitis, and periodontitis among these children.3.
Studies were carried out in different countries to assess the oral health status in children with bleeding disorders5,106,118. However, in Egypt there is no sufficient data about the evaluation of caries risk, oral health status and effect of oral health promotion on these children. Thus, the present study was conducted to assess the caries risk, address the oral findings commonly noticed in children with bleeding disorders and evaluate the effect of oral health education in promoting the oral health of these children throughout a 6-month- follow-up period.
The present study was carried out on a group of 65 Egyptian children with bleeding disorders aged from 2 to 18 years. Male to female ratio was 2:1 in the present study most probably because hemophilia is more common in males.
The American Academy of Pediatric Dentistry Caries-risk assessment tool (CAT) was used in the study to illustrate the caries risk profile of each child, to predict caries risk and aid in health education for parents of these children. At the baseline of the present study, the majority of children (95.4%) showed high caries risk profile.
The status of caries experience was recorded Caries Assessment Spectrum and Treatment (CAST) index. The values of DMFT, deft and dmft in the present study were calculated from CAST index using the median and interquartile range as both are not influenced by extreme values which were present in the patients’ raw data. The low caries prevalence among the study population can be attributed to the fact that the DMFT index underestimates the experience of caries in children with late mixed dentition because they have typically lost most of their primary teeth and caries in the primary dentition probably accounts for much of the problem with dental caries in childhood. Moreover, the permanent teeth were in early stages for developing dental caries.
In the present study, the oral hygiene index simplified (OHI-S) was used for assessment of oral hygiene status. The mean oral hygiene index simplified was classified as follows: the majority of patients (80.4%) were in the good level (OHI-S: 0.1–1.2), while (16.1%) of the children were in the fair level (OHI-S: 1.3–3.0) and (3.6%) of them were in the poor level (OHI-S: 3.1– 6.0).
In the present study the Modified Gingival Index, which is a non- invasive approach-was used to evaluate gingival inflammation to minimize the risk of gingival bleeding. In the present study, the mean Modified Gingival index was (1.29±0.47) where the majority of the patients (71.4%) had mild gingivitis, while (26.8%) of the children had moderate gingivitis and (1.8%) of them had severe gingivitis. The acceptable oral hygiene status, relatively low debris index and acceptable gingival health found in bleeding disorders patients might be due to the hematologist’s instructions to always wipe their
teeth and gingival tissues with a piece of gauze or cotton soaked with antibacterial mouthwash, especially after meals.
Oral health education for patients and their caregivers was performed using a specially designed booklet which included recommendations and instructions about daily routine dental hygiene, dietary modifications and importance of regular dental checkups to prevent gingival disease and build- up of calculus, which will increase bleeding tendency and accelerate dental caries.
After extensive 6-months-follow-up period of good oral hygiene practice and diet modification, for all caries indices, the effect was not statistically significant (p>0.05) because preventive measures are ineffective in irreversible stages of carious lesions. However, there was a significant reduction in oral debris index and modified gingival index after health promotion (p<0.05). For gingival health, there was a significant increase in percentage of cases with normal gingiva and a significant reduction of cases with mild, moderate and severe gingivitis (p<0.001).
Regarding the presence of oral bleeding, at the baseline of the present study 37.5% of the children had oral bleeding. While after follow-up period, only (7%) of children had oral bleeding .Also, there was a significant increase in prevalence of tooth brushing among the patients, where almost half of the patients (46.6%) reported brushing their teeth once per day and (14.3%) of the patients brushed their teeth twice per day. This clearly reflects that patients with bleeding disorders positively respond to oral health education and can achieve an improvement in oral hygiene status when properly guided and educated.