Oral Clues to Undiagnosed Congenital Hemophilia: A Systematic Review of Case Reports.

Objective: To analyze the oral symptoms documented in case reports that led to the identification of undiagnosed hemophilia.

Methods: An electronic database search was carried out using MEDLINE (via PubMed), Scopus, CINAHL, ProQuest and EMBASE databases from inception to August 2025 for case reports and case series published in English language. Case reports addressing the dental treatments for people with hemophilia A/hemophilia B were included. Cases of acquired hemophilia and cases of hemophilia who are inhibitor positive were excluded.

Results: There was a total of 282 articles that were identified of which seven reports (6 case reports and one case series) documented that prolonged oral bleeding following dental extraction was the first sign to suspect undiagnosed hemophilia. Delayed post-dental treatment bleeding from Day 2 should raise the suspicion toward undiagnosed hemophilia A/B.

Conclusions: Mild hemophilia is often overlooked and undiagnosed due to the clinical manifestations that may be often neglected. Hence, this systematic review highlights the importance of dental professionals being the forefront of diagnosis of undetected bleeding disorder.