ELGAMAL HATEM - 5th Course – Group: 6610ca

Topic No.13
Manifestations in the oral cavity of the blood system diseases in
children. Dentist’s tactics.

Iron-deficiency anemia is a disease which is characterized by decreased

hemoglobin level, decreased hemoglobin concentration in each erythrocyte, low
content of iron in blood serum at increased general data of iron-binding factor.
Etiology: the disease may appear as a result of disordered iron metabolism.
The deficiency may be caused by:
1. Inadequate consumption of iron (Fe) in comparison with increased
requirements of a child’s body, which is caused by his growth.
2. Diminished intake of iron with food.
3. Exhaustion of iron deposits in pregnant women and premature children.
4. Disordered absorption of iron in the alimentary canal.
5. Chronic purulent focal infections, blood loss.
Clinical picture: the patients complain about weakness, dizziness,
increased fatigue. There may be disordered taste and smell sense. The skin and
mucosa are pale. The gastric and intestinal secretions are decreased. The skin is
dry, the nails and hair brittle. The skin fissures may appear on the skin and
mucosa borders, especially in the lip corners. There are considerable changes on
the tongue surface. As a result of the filiform papillae’s atrophy, the tongue
becomes vividly red, smooth, polished (desquamative glossitis).
The children may develop a dystrophic process of the hard dental tissues,
multiple caries. The immunity may become reduced (frequent respiratory viral
infections, pneumonias, chronic focal infections).
The peripheral blood is characterized by decreased erythrocyte content, low
hemoglobin level (<110 g/l). The color index is low (0,6-0,8).
The treatment is symptomatic.
1. The treatment of a desquamative glossitis includes coating medications
(sage, chamomile, fruits of bilberry, calendula).
2. Special diet (meat, vegetables).
3. Administration of iron drugs, vitamins.
 Leucosis – is a malignant disease of haemopoetic tissue with primary
localization of the pathological process in the bone marrow and foci of the
leukemic metaplasia in various organs.
There are acute and chronic leucoses. The acute leucoses are characterized
by pathological overgrowth of the immature blast cells. According to the
predominating symptoms it is possible to distinguish the anemic, ulcerative-
necrotic, hemorrhagic, septic, tumor and combined forms of the disease.
Clinical picture: the onset of the disease is characterized by some
complaints about pain in the bones and joints, increased fatigability, increased
body temperature. The oral changes may serve primary symptoms of the
pathological process’ development. The skin and mucosa of the mouth are pale,
wax-like. It is possible to observe the hemorrhagic syndrome as the pinpoint
petechiae or gross hemorrhage into the mucous membranes, subcutaneously,
nasal and gingival bleeding. The acute leucosis is characterized by considerable
(leukemic) infiltrates of the gums. The infiltrate is more vividly expressed around
the palatial or lingual surface of the teeth. the clinical signs may be increased
lymphatic nodes, hyperplasia of the lymphoid apparatus of the tongue and soft
palate as well. Sometimes the Mykulich’s symptoms may be detected – a
symmetric increase of the salivary and lacrimal glands. The gingival papillae are
grossly swollen, papillitis may proceed. The majority of the patients determine
mobility of the teeth because of the leukemic infiltrate in the periodontium. The
malformations in the gums and gum margin cause gum deformation. Because of
the decreased oral local immunity a fusospirochetal infection may affect the oral
cavity, are active gingivostomatitis may appear, there may develop leukemic
fissures.
The leucosis may be manifested in the oral cavity with chronic candidosis,
a grey-white foamy “fur” on the tongue’s back, which is easy to be removed.
Sometimes pseudomembranous form of candidosis may develop, and it is
characterized by a diffuse lesions of the oral cavity expressed as a “film” coating,
which is difficult to be removed.
The blood count at acute leukocytosis is characterized by the following:
1. Undifferentiated cell elements – blasts – in a leukogram.
2. Leukemic “gap” (hiatus leucemicus), which indicates the absence of
intermediate forms between the undifferentiated cells and mature
neutrophils.
3. Absent eosinophils and basophils in the leukocyte count.
4. Acute anemia and thrombocytopenia (Hb 20-30 g/l, erythrocytes 1,0-
1,5х1012 per l.).
Treatment: oral cavity hygiene in children.

Chronic leucosis is more often observed in children.

The lymphoblast leucosis is characterized by hyperplasia of the lymphatic
system’s oral tissue, increased lymph nodes and tonsillar pillars. The gum
infiltration is possible as well as haemorrhage from the pale oral mucosa.
Hemorrhagic diathesis. This group includes the diseases which are
characterized by a bleeding syndrome.
According to a mechanism which causes the bleeding, the haemorrhagic
diathesis may be classified as follows:
I. Hemorrhagic diathesis stipulated for the thromocyte changes.
1. Idiopathic thrombocytopenic purpura (Verlgolf’s disease).
2. Hemorrhagic thrombastheny (Glantsman’s disease).
II. Hemorrhagic diathesis stipulated for the inadequate plasma coagulation
factor action:
1. Hemophilia.
2. The diseases related to the insufficiency of the prothrombin complex.
III. Hemorrhagic diathesis caused by vascular disorders:
1. Hemorrhagic vasculitis (Shenlein-Genoch’s disease).
2. Hemorrhagic teleanginoectasy (Randu-Osler’s disease).
Idiopathic thrombocytopenic purpura (Vergolf’s disease):
The main symptom is bleeding from the mucosa of the gums, stomach,
intestines, and nose as well. The peculiar trait of these bleeding is absent blood
clots. The endothelial tests in the crisis period prove to be positive.
The bleeding may be caused by:
1. Thrombocytopenia.
2. Affected resistance of the vessel walls.
It is possible to observe bleeding into the skin, mucosa of the hard and soft
palate, cheeks, lips, gums, tonsillar pillars. They appear at different time periods,
this is why they can be colored differently. The blisters with bloody content
appear. Hemorrhages are characteristic (ecchymosis, petechiae).
Hemophilia: an inherited disease which is characterized by insufficient
thromboplastin formation.
 The doctor may observe bleeding from the oral mucosa during the period of
physiological teeth change and if they are injured. The bleeding from the other
organ’s mucosa may appear as well. The peculiarities of the haemorrhagic
syndrome are the following: late bleeding ( in 6-12 hours after then
traumatizing).
Laboratory analysis:
1. Protracted time period of blood coagulation, 10-30 min.
2. Slow blood clot retraction.
3. Thromboplastin formation is disordered.
4. Decreased antihaemophillic factors (VIII, IX, XI).
Treatment: Oral cavity sanation.
Hemorrhagic vasculitis (Shenlein-Genoch’s disease)
is characterized by a hyperergic inflammation of the vessels with the subsequent
microvasculitis development. The children are affected more often.
Clinical picture:
The disease has acute onset. The features characteristic for it are:
1. Haemorrhagic syndrome, manifested on the feet, hips, trunk.
2. Joint syndrome ( which affects the large joints).
3. Abdominal syndrome (abdominal pain, nausea, bloody diarrhea).
There are haemorrhagic eruptions in the oral cavity.
The blood data are as follows: neutrophilic leukocytosis (12-18х109 per l.),
ESR – 20-50 mm per hour.