Smoking should be avoided as this can cause problems with healing. Regular warm

salt water mouthwashes (a teaspoon of salt in a glass of warm water) should begin the day after treatment and continue for 5–7 days or until the mouth has healed. Prolonged bleeding and/or difficulty in speaking, swallowing, or breathing following dental manipulation should be reported to the hematologist/dental surgeon immediately. Non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin must be avoided. An appropriate dose of paracetamol/acetaminophen every 6 h for 2–3 days will help prevent pain following an extraction. The presence of blood-borne infections should not affect the availability of dental treatment. Prevention of bleeding at the time of dental procedures in patients with inhibitors check details to FVIII or FIX requires careful planning [61]. Hemophilia is an X-linked disorder that typically affects males, while females are carriers. Obligate carriers are: daughters of a person with hemophilia mothers of one son

with hemophilia and who have at least one other family member with hemophilia mothers of one son with ALK inhibitor hemophilia and who have a family member who is a known carrier of the hemophilia gene mothers of two or more sons with hemophilia The expected mean clotting factor level in carriers of hemophilia is 50% of the levels found in the healthy population [1, 2]. Most carriers are asymptomatic. Carriers with clotting factor levels of 40–60% of normal may have an increased bleeding tendency [3]. A few carriers may have clotting factor levels in the hemophilia range – mostly in the mild category – but in rare instances, carriers can be in the moderate or severe range due to extreme lyonization. (Table 1–1) Carriers with clotting factor levels in the hemophilia range may be symptomatic with bleeding manifestations commensurate with their also degree of clotting factor deficiency, particularly during trauma and surgery [3]. Menorrhagia and bleeding after medical interventions are the most common manifestations among carriers with significantly low factor levels [3]. Carriers with low clotting factor levels should

be categorized as having hemophilia of appropriate severity and managed accordingly. Birth control pills and antifibrinolytic agents are useful in controlling symptoms of menorrhagia. Levels of factor VIII increase significantly in pregnancy. Levels of factor IX, however, do not usually change significantly [4]. Immediate female relatives (mother, sisters, and daughters) of a person with hemophilia should have their clotting factor level checked, especially prior to any invasive intervention, childbirth, or if any symptoms occur. (Level 3) [ [5, 3] ] Where available and possible, genetic testing for carrier status should be offered to at-risk female family members of people with hemophilia to facilitate genetic counseling, and if desired by the family, prenatal diagnosis.