Tuesday, November 28, 2017

Oral manifestations in patients with aplastic anemia


Article Title:  Oral manifestations in patients with aplastic anemia
Author(s): Brennan MT, et al
Journal: Oral Surgery Oral Medicine Oral Pathology
Date: 2001; 92: 503-8
Major Topic:
Type of Article:
Main Purpose:  This article aimed to describe the prevalence and risks of oral complications in aplastic anemia.
Key Points: Oral soft tissue changes and infections are more common in patients with aplastic anemia.
·      Aplastic Anemia = serious hematologic disease characterized by bone marrow that produces insufficient numbers of hematopoietic stem cells, leading to deficient production of erythrocytes, granulocytes, and platelets (ie pancytopenia) à deficiency in all 3 blood types
o   ~1/2 million
o   Unknown etiology
o   Symptoms: fatigue, easy bruising, epistaxis, gingival hemorrhage
o   Increased infection risk due to pancytopenia
o   Bacterial sepsis and fungal infections are most frequent cause of death
·      Treatment of aplastic anemia
o    Immunosuppressive drugs are 1st line such as steroids and cyclosporine
o   Hematopoietic stem cell transplantation may also be used
o   85% 5 year survival rate with modern treatment
·      Patients with aplastic anemia have increased risk of presenting with:
o   Petechiae
o   Gingival hyperplasia
§  More common in mandibular anterior and in patients with poor OH
§  Associated with cyclosporine use
o   Spontaneous gingival bleeding
o   Herpetic ulcerations
·      Oral manifestations that have been described with aplastic anemia: pallor, submucosal hemorrhages, gingival swelling, herpetic lesions, spontaneous gingival bleeding, periodontal disease
·      5/10 patients with aplastic anemia had complications after extractions – bleeding, hematoma, fever
·      No complications reported for nonsurgical restorative, periodontal, or endodontic treatment
·      ~30% of patients treated with cyclosporine develop gingival hyperplasia (prevalence and severity increases with poor OH)
·      Advanced or rapidly progressive periodontal disease can occur in patients with prolonged neutropenia (cyclic neutropenia, agranulocytosis, leukocyte adhesion deficiency) à routinely examine patients with aplastic anemia for periodontal effects
·      Patients with aplastic anemia are at increased risk of oral fungal and bacterial infections à routine dental examinations are important
·      Article recommends extractions and invasive procedures on patients with aplastic anemia be done in a hospital setting 

Remarks:
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Assessment of Article:  Level of Evidence/Comments: III


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