Hematologic Diseases ( Must Know Points)

Disease	Oral manifestation	Dental consideration
Anemia (most of them)	Petechiae, Spontaneous gingival bleeding, herpetic infection, glossitis, stomatitis, angular cheilitis, pale oral mucosa, oral candidiasis, RAS, erythematous mucositis, burning mouth.	·        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
Polycythemia vera	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.
Sickle cell disease	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.

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	The primary concern is the level of anemia; however, it is rarely of clinical significance.
White blood cell disorder	Enlarged gingiva, oral ulcers, oral infection due to immune suppression from disease or therapy recurrent gingivitis, severe periodontitis, alveolar bone loss, and ulceration.	·        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.
Refer your seminars for leukemia, lymphoma, chediak higashi syndrome and additional essential readings, especially hematologic investigations and bleeding and clotting disorders.