Oral Manifestations Of Bood Disorders

Oral Manifestations Of Bood Disorders

Question 1. Write a short note on pernicious anemia.
Answer.

Pernicious Anemia Causes

• It occurs due to atrophy of gastric mucosa resulting in failure to secrete still unidentified intrinsic factor.
• It is suggested that it is an autoimmune disorder, because autoantibodies to gastric parietal cells are often found in patients.

Oral manifestations of blood disorders

Pernicious Anemia Management

• For first week daily subcutaneous administration of vitamin B12 is given. If reticulocytosis is seen, then administration of vitamin B12 twice weekly for around 4 to 5 weeks. As this is over 100 µg of vitamin B12 should be administered monthly either subcutaneous or intramuscular route.
• Patient who does not consume vitamin B12 rich foods such as eggs, meat or milk should be given supplemental vitamin B12. 100 to 200 µg should be given orally either in tablet or in syrup form.
• Physical activity should be done.

Thrombocytopenia and oral bleeding

Question 2. Write short note on Aplastic Anemia
Answer. It is a rare disorder characterized by peripheral blood pancytopenia (anemia, leukopenia and thrombocytopenia associated with bone marrow suppression)

Aplastic Anemia Types

• Primary: It is the disease of unknown origin which occurs most frequently in young adults, develops more rapidly and terminates fatally.
• Secondary: It has known etiology which occurs at any age and present better prognosis.
• Etiology
• Drugs and chemicals: Drug-related aplastic anemia develop in three ways, i.e.
  • Characterized by myelosuppressive effect of cancer chemotherapeutic agents.
  • Some drug can cause marrow depression.
  • The third type is idiosyncratic or hypersensitivity induced aplastic anemia.
  • Common drugs are benzene derivatives, chloramphenicol, amidopyrins organic arsenicals, colloidal silver, bismuth, mercury, sulfonamides, penicillin and anti-cancer drugs.
• Infections: Patients with bacterial disease such as tuberculosis and viral infections like hepatitis and infection mononucleosis can cause pancytopenia.
• Radiation: Long-term continuous exposure, to small amounts of external radiation or to internally deposited radium or thorium has been followed by development of aplastic anemia.
• Other causes: Pregnancy and thymoma can also cause aplastic anemia.

Aplastic Anemia Clinical Features

• It can occur at any age, but is common in young adults.
• Patient may feel weakness after slight physical exertion and exhibit pallor of skin
• Breathlessness, headache, ankle edema are common
• Numbness and tingling of extremities with edema
• Anemia may be severe enough to cause anginal pain or congestive cardiac failure
• There may be bleeding from various sites such as skin, nose, vagina and gastrointestinal tract associated with fever due to infection.

Aplastic Anemia Oral Manifestations

• Oral mucosa is pallor.
• In some of the cases, spontaneous hemorrhage may occur from gingiva.
• Petechiae, often are present on the soft palate and in severe cases, there may be submucosal ecchymosis
• Large-ragged ulcers which are covered by gray or black necrotic membrane may be present, which results in generalized lack of resistance to infection and trauma.

Aplastic Anemia Diagnosis

• Clinical diagnosis: Features such as thrombocytopenia, deficiency of WBCs i.e. presence of infection, deficiency of erythrocytes i.e. presence of pallor provide clue to diagnosis.
• Laboratory diagnosis or investigations:
  • Decreased RBC count as low as 1 million cells/mm3.
  • Count of WBCs is 2000 cells/mm3
  • Platelet count falls below 20,000 cells/mm3
  • Decrease in absolute reticulocyte count.
  • Prolonged bleeding time and normal clotting time.
  • Normocytic anemia along with some degree of macrocytosis.
  • Bone marrow is fatty with few developing cells.

Oral lesions in vitamin B12 deficiency

Aplastic Anemia Management

• Withdrawal of etiologic agent
• Supportive therapy should be in form of antibiotics and transfusion
• Stimulation of hemopoiesis by androgens
• Bone marrow transplantation can be useful in some cases
• Antifibrinolytic agents: Gingival bleeding can be reduced by using systemic antifibrinolytic agents such as aminocaproic acid or tranexamic acid and local treatment.

Question 3. Write short note on oral manifestations of leukemia.
Answer. Oral manifestations of leukemia:

Acute Leukemia

The submental, cervical, pre and postauricular lymph nodes may be enlarged and tender.

Leukemia Symptoms

• Paresthesia of lower lip and chin is present.
• There may be toothache due to leukemic cell infiltrationof dental pulp.

Leukemia Signs

• The oral mucus membrane shows pallor, ulceration of necrosis, petechial, ecchymosis and bleeding tendency.
• There may be massive necrosis of lingual mucosa with slough-ing, gingiva shows hypertrophy and cyanotic discoloration.
• The gingiva appears boggy, edematous and deep red, bleeds easily due to ulceration of sulcus epithelium and necrosis of underlying tissue.
• Mobility of permanent tooth is present.
• Oral infections (candidal, viral and bacterial) are serious and potentially fatal complication in leukemic patient.

Gingival swelling in leukemia

Chronic Leukemia

• Gingiva: Most common oral finding is hypertrophy of gingiva. There may be ulceration with necrosis and gangrenous degeneration.
• Tongue: The tongue is swollen and dark.
• Lymph nodes: There is regional lymphadenopathy.
• Teeth: Rapid loosening of teeth due to necrosis of PDL. Destruction of alveolar bone occurs.