Dental extraction, one of the most common invasive procedures in dentistry, can be complicated by perilous oral bleeding, especially in people with an inherited bleeding disorder such as hemophilia (Van Galen et al., 2019). Hemophilia is a hereditary X-linked recessive disorder caused by a deficiency of either clotting factor VIII (hemophilia A), IX (hemophilia B), or XI (hemophilia C). The prevalence of hemophilia A (also known as classic hemophilia) is estimated at 1 in 6000 men, while that of hemophilia B (or Christmas disease) is 1 in 30 000 men (Liras and Romeu, 2019). Hemophilia can been classed as severe (having less than 1% of normal plasma factor levels), moderate (1–5% of normal plasma factor levels), and mild (5–40% of normal plasma factor levels) (Srivastava et al., 2020).

A recent report suggested that the mouth is one of the most common sites of perceived life-threatening bleeding among hemophiliacs, who are at high risk of intraoperative and postoperative bleeding (Srivastava et al., 2020). Until around 1970, dental extraction in these patients required multiple transfusion and prolonged hospitalization. The introduction of clotting factor concentrates and local hemostatic agents has modified the approach to dental extractions in hemophiliacs (Vinckier and Vermylen, 1985). Desmopressin (DDAVP), a synthetic vasopressin derivative, has been shown to raise factor VIII levels only in individuals with mild or moderate hemophilia A or von Willebrand disease type 1. Moreover, DDAVP releases bound factor VIII, and hence it cannot be used to treat hemophilia B patients (Kobrinsky et al., 1984). Although not supported by high-quality data, use of local or systemic antifibrinolytic agents, following a single infusion of factor VIII or IX, has resulted in lower incidences of bleeding complications (Sindet-Pedersen and Stenbjerg, 1986; Freedman et al., 2009; Van Galen et al., 2019). The required units of factor VIII or IX required for use in hemophilia patients varies in the literature, but achieving 30% of normal factor levels is considered a standard requirement for a single tooth extraction (Zanon et al., 2000; Peisker et al., 2014; Srivastava et al., 2020). However, this standard protocol, which has been used for decades, is not reliable and is sometimes not enough to prevent hemorrhagic complications. The authors’ institute, being a tertiary care center, is attached to the biggest hemophilia day care center in New Delhi, offering dental treatment to many patients with hemophilia. Here, severe post-extraction bleeding has been reported, in spite of following the standard protocol rigorously (Sharma et al., 2015).

The breakthrough for dental laser systems came in the mid 1990s (Frentzen and Koort, 1990; Beatriz et al., 2019). The ability of diode lasers to seal off small blood and lymphatic vessels, resulting in hemostasis and reduced postoperative edema, is already proven (Pirnat, 2007). Although the use of lasers in achieving hemostasis in hemophiliacs has been documented since the early 1980s (Somma et al., 1981), there has been a paucity of research relating to procedures in oral surgery, especially in the utilization of low-level laser therapy (LLLT). A study conducted at the authors’ institute has already shown promising results regarding pain and wound healing when LLLT was used following orthodontic extractions (John et al., 2020). The present prospective cohort study aimed to evaluate the efficacy of adjuvant LLLT, along with the standard protocol, in achieving post-extraction hemostasis in patients with hemophilia.