Blood Disorders

Neutropenia
Polycythemia Vera
Anemias
Hemophilia
Platelet Disorders

Neutropenia
Oral Effects
People with neutropenia have low levels of white blood cells called neutrophils. These cells are the first line of defense against bacterial infections. Neutropenia can be caused by medicines that interfere with how these cells are made by the bone marrow. Some diseases, such as HIV/AIDS, also can cause neutropenia.

If you have neutropenia, you are more likely to get infections. That includes infections in your mouth. However, you may not notice signs of infection. That's because neutrophils normally cause the redness and swelling that are signs of infection. If there aren't enough neutrophils, you may not have redness or swelling, even if you have an infection. This means infections, such as periodontal (gum) disease yeast infections and oral ulcers, can get worse quickly.

People with severe neutropenia can have deep ulcers (sores) in their mouths. These sores are often painful.

At the Dentist
People with neutropenia are sometimes given antibiotics before they have major dental treatment. This helps protect them from infections. A normal neutrophil count is between 3,000 and 6,000 cells. Generally, if your neutrophil count is less than 1,000, you will need antibiotics. Sometimes you may have to take the antibiotics for several days after treatment as well. If you have neutropenia or are taking medicines that can cause neutropenia, give your dentist an updated copy of your blood test results every time you visit.

Polycythemia Vera
Oral Effects
People with polycythemia vera have too many red blood cells. Because of this, they are more likely to get blood clots. They can have purplish or red areas on the tongue, cheeks, lips and gums.

This condition can occur on its own. It also can happen when your body responds to a lack of oxygen. Heavy smokers, people with emphysema and people who move to very high altitudes may get polycythemia.

At the Dentist
People with polycythemia vera usually see a dentist who specializes in treating people with other health conditions. This helps reduce the risks of bleeding and blood clots. Your dentist probably will want you to get a blood test before you have treatment. If certain tests are not normal, your dentist will talk with your physician before treatment.

Anemias
Oral Effects
People with anemia do not have enough hemoglobin. Hemoglobin carries oxygen in your blood. Anemia can be caused by:

• Blood loss
• Fluid overload
• Increased destruction of red blood cells
• Decreased production of red blood cells
• Nutritional deficiencies
• Defects in the hemoglobin molecule

Types of anemia include iron-deficiency anemia, aplastic anemia, sickle cell anemia, pernicious anemia and thalassemia.

If you have anemia, the inside of your mouth may look very pale. Your tongue may look smooth. X-rays sometimes show changes in the jawbone.

At the Dentist
People with certain types of anemia, such as aplastic anemia, are at higher risk for infections. Your dentist may give you an antibiotic mouthwash rinse, antibiotic pills or both. You should take these before a dental procedure. Before major dental treatment, you may receive a drug to reduce the risk of uncontrolled bleeding. This is called an antifibrinolytic drug. During treatment, the dentist will avoid certain types of injections that could cause bleeding problems.

If you have sickle cell anemia, get your teeth cleaned during non-crisis periods. Keep your appointments short. Before any dental treatment (like a filling or root canal), get a blood test and have your doctor and dentist review the results.

Anyone with a chronic anemia, such as thalassemia, may heal very slowly. If you have a chronic anemia, talk to your dentist to see if any special procedures or precautions are needed. This type of disease can affect your blood counts, too. Give your dentist a copy of your blood test results.

Extra oxygen may be given to you to breathe during dental visits or treatments.

Hemophilia
Oral Effects
People with hemophilia are missing important proteins (also known as factors) that help the blood to clot. If you have hemophilia, your mouth may bleed often. You may try not to brush and floss as much as you should, because brushing and flossing sometimes make your mouth bleed. Because of this, you may have more dental problems than healthy people.

At the Dentist
Before dental treatment that might cause bleeding, hemophiliacs may need extra blood products (factor-replacement therapy). This will increase the amount of clotting factor in the blood. If you need blood products or proteins for dental procedures, you may need to have your treatment in a hospital. However, some people can administer the blood products themselves. Talk to your medical doctor and dentist about your condition. You also should have blood tests before treatment. These tests will show the levels of blood proteins and show if you are at risk for uncontrolled bleeding.

If you have hemophilia, your dentist probably will avoid an anesthetic shot called a block injection. Sometimes, this type of injection can cause a swelling or bruise under the skin. This is called a hematoma.

IIf you need extensive dental surgery, you may need to be treated in a hospital operating room while under general anesthesia.

In most cases, these procedures are safe:

• Fillings and crowns
• Root canal treatment
• Getting fitted for dentures, or having dentures refitted or relined
• Orthodontia, without sharp brackets or wires

Your dentist will try to minimize bleeding. People with braces should avoid cuts from brackets, wires and bands. Some experts suggest that it's better to have orthodontic appliances that are attached to your teeth rather than the kind that you can take out of your mouth. In this case, you would need close follow-up by your dentist. The ultimate goal is to decrease the chances of any bleeding.

Oral surgery poses the greatest risk of severe bleeding. Oral surgery should only be done if needed. You and your dentist should still take precautions with the help of your physician (hematologist). Your dentist will use medicines and surgical techniques to minimize bleeding. You should:

• Replace missing blood-clotting (coagulation) factors, up to 50% to 100% of normal, before surgery.
• Replace blood-clotting factors after surgery as necessary.
• After surgery, consider taking a medicine that prevents blood clots from breaking down.
• Eat soft foods.

Platelet Disorders
Oral Effects
Platelets help the blood to clot. People without enough platelets have blood that doesn't clot well. They can have uncontrolled bleeding. Two of the most common platelet disorders are idiopathic thrombocytopenia purpura and thrombotic thrombocytopenia purpura.

People with platelet disorders may be afraid that their gums will bleed when they brush their teeth. This means they may not brush enough, so they might have more cavities and gum disease.

At the Dentist
Before each visit, your dentist should get a copy of your most recent blood test results.

A normal platelet count is between 150,000 and 400,000 cells. People with platelet levels below 20,000 run the risk of unprovoked bleeding. They should have dental treatment in a hospital with a platelet transfusion.

People with platelet levels between 20,000 and 50,000 should be treated by a dental specialist trained in oral medicine, hospital dentistry or oral surgery. He or she will use special surgical techniques and products to reduce the risk of uncontrolled bleeding. A platelet infusion also may be necessary.

For people with platelet levels above 50,000, most types of treatment are safe. For discomfort, you should not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil and others). These drugs can make it more difficult for blood to clot. In addition, your dentist should be careful when giving a block injection (a local anesthetic shot in your lower jaw) or should avoid this type of injection. It can result in a swelling or bruise under the skin called a hematoma.

People with braces should avoid cuts from brackets, wires and bands. Some experts suggest that it's better to have orthodontic appliances that are fixed (attached to your teeth) rather than those that you can take out of your mouth. In this case, you would need close follow-up by your dentist. The ultimate goal is to reduce the chances of any bleeding.