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 drugs used for cancer treatment can cause neutropenia. Radiation treatment also can cause it. Some diseases can cause neutropenia. These include autoimmune diseases, cancer and AIDS. Some people are born with a problem with bone marrow production. This is called congenital neutropenia.
If you have neutropenia, you are more likely to get infections. 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.
People with polycythemia vera have abnormally high numbers of red blood cells. Because of this, they are more likely to form blood clots. They can have purplish or red discoloration of the tongue, cheek, lips and gums.
Primary polycythemia vera is a disorder of red blood cells. Secondary polycythemia vera usually occurs in response to a lack of oxygen. Your body senses that your oxygen level is low and makes up for it by making more red blood cells, which carry oxygen. Heavy smokers, people with emphysema and people who move to a very high altitude may have secondary polycythemia.
At the Dentist
People with primary polycythemia vera usually are treated by a dental specialist rather than a general dentist to minimize complications such as bleeding and blood clot formation. Your dentist probably will require a blood test to see if certain blood levels (such as hemoglobin and hematocrit) are normal. If specific blood tests are not normal, special considerations in collaboration with the primary physician must be planned out in advance of dental treatment.
People with anemia do not have enough hemoglobin. Hemoglobin carries oxygen in your blood. People with anemia often feel tired. 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
- Diseases that affect bone marrow, such as leukemia (blood cancer)
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 prescribe 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 (such as a filling or root canal), get a blood test and have your physician 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.
You may be given extra oxygen to breathe during dental visits or treatments.
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 physician and dentist about your condition. You may need to 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.
If you need extensive dental surgery, you may need to be treated in a hospital operating room while under general anesthesia. Scaling and root planing may also need to be done in a hospital. This is a treatment for periodontal disease that involves deep cleaning of the teeth and roots. It can cause bleeding.
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. The ultimate goal is to decrease the chances of any bleeding.
Oral surgery poses a risk of severe bleeding. Your oral surgeon will talk to your hematologist before your surgery. Preparation will depend on your condition and what surgery you plan to have. You may need to:
- Replace missing blood-clotting (coagulation) factors, up to 50% to 100% of normal, before surgery
- Replace blood-clotting factors after surgery as necessary
- Follow all instructions given to you after surgery
- Eat soft foods
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. Your dentist will work closely with your hematologist in planning and performing your treatment.
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 and may need a platelet transfusion.
People with platelet levels between 20,000 and 50,000 should be treated by a dentist trained in oral medicine, hospital dentistry or oral surgery. He or she will use 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.
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.
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