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Disease
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Oral manifestation
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Dental consideration
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Anemia (most of
them)
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Petechiae,
Spontaneous gingival bleeding, herpetic infection, glossitis, stomatitis,
angular cheilitis, pale oral mucosa, oral candidiasis, RAS, erythematous
mucositis, burning mouth.
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·
Goal: establish and maintain good oral health, thus
reducing the risk of an oral infection.
·
For patients who are severely neutropenic
(neutrophil count <200/micro lit), prophylactic antibiotic and antifungal
should be used and foods that may be contaminated with bacteria or fungal
pathogens avoided.
·
Attention to details of oral hygiene and hand
washing and avoidance of minor injuries and exposure to infectious agents can
reduce risk of serious complications
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Polycythemia
vera
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PV can manifest
intraorally with erythema (red-purple color) of mucosa, glossitis, and
erythematous, edematous gingiva.
Spontaneous
gingival bleeding can occur because the principal sites for hemorrhage,
although rare, are reported to be the skin, mucous membranes, and
gastrointestinal tract.
|
·
Control of hemorrhage after dental surgery should be
considered
·
Clinically significant bleeding may require platelet
transfusion and
a role for e-aminocaproic acid and tranexamic acid has been suggested by
some. Other
measures to consider in preparing the patient with PV for routine dental
surgery include obtaining better control of blood counts by phlebotomy or drug
therapy and adjustment of any concomitant antiplatelet and/or anticoagulant
therapy.
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Sickle cell
disease
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Higher risk of
osteomyelitis (Salmonella and Staphylococcous Aureus.
Radiographic
findings in patients with SCA include a “stepladder” trabeculae pattern
(70%), enamel hypomineralization (24%), calcified canals (5%), increased
overbite (30–80%), and increased overjet (56%). Patients may also have pallor of the
oral mucosa and delayed eruption of the teeth.
|
The need for
antibiotic prophylaxis is controversial.
Other management
considerations for patients with SCA include maintaining good oral hygiene,
routine care during noncrisis periods, aggressive treatment of oral
infection, avoidance of use of aspirin, caution with respiratory-depressing
conscious sedation, and avoidance of long, stressful dental visits. Use of
nitrous oxide–oxygen for anxiolysis is safe, with maintenance of adequate
flow rates.
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Hematologic
Diseases
(Few
must know aspects)
|
Thalassemia
|
Radiographic features of jaws and teeth
among people with thalassemia major include the appearance of spiky-shaped
and short roots, taurodontism, attenuated lamina dura, enlarged bone marrow
spaces, small maxillary sinuses, absence of inferior alveolar canal, and thin
cortex of the mandible.
“chipmunk faces”
Dental arch morphologic changes include
a narrower maxilla and smaller incisor widths for the maxillary and mandibular
arches.64 Consistent
with gen- eral growth retardation, dental development of patients with
b-thalassemia major was found to be delayed by a mean of 1.01 years,
increased with age, and was higher for boys than girls compared with
unaffected children.
higher dental caries experience
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The primary concern is the level of
anemia; however, it is rarely of clinical significance.
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White
blood cell disorder
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Enlarged gingiva, oral ulcers,
oral infection due to immune suppression from disease or therapy
recurrent gingivitis, severe
periodontitis, alveolar bone loss, and ulceration.
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·
Measures to decrease sources of infection.
·
Prophylactic antibiotics have historically been
recommended by some for patients with a hematologic malignancy–caused ANC
<1,000 cells/mm3 prior to dental extractions.
·
Typically in the dental setting, the drugs and
regimens supported by the most recent American Heart Association guidelines
for infective endocarditis prevention are used prior to invasive dental procedures.
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Refer
your seminars for leukemia, lymphoma, chediak higashi syndrome and additional
essential readings, especially hematologic investigations and bleeding and
clotting disorders.
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