CIRCULATORY DISORDERS STUDY NOTE - Alma Fuentes

BLOOD DISORDERS:
- RDH Considerations:
- Oral soft tissue changes (exaggerated due to biofilm)
- Lowered resistance to infection
- Bleeding tendencies
- Potential need to delay treatment or have antibiotics prior to treatment

ANEMIA

- Reduction in RBC to below normal

- Considered a symptom of other illnesses or diseases
- Disease IS CLASSIFIED BY CAUSE
- Blood loss
- ACUTE
- Trauma or disease
- CHRONIC
- Internal bleeding
- Gastrointestinal or gynecologic
- Results in iron deficient anemia
- Increased hemolysis
- Hereditary
- Sickle Cell Disease
- Acquired
- Drugs, infections
- Hemolytic disease of the newborn-mother is Rh + and fetus is
Rh -
- Diminished production of RBC
- Nutritional deficiencies
- Inadequate nutrition
- Defective absorption in GI tract
- Pregnancy
- Pernicious (B 12 vitamin deficient absorption deficiency) ,
iron-deficient, celiac disease (sprue)
- Bone marrow failure
- Aplastic anemia (AA)-can occur without apparent cause or
when bone marrow is injured by medications, radiation,
chemotherapy or infection
- AA is combination of anemia, neutropenia, and
thrombocytopenia leading to large decrease in all cells formed
in bone marrow
- *RDH Consideration - AA must have a MD consult prior to
care-pre-med
- Chronic Disease
- 2nd most common after iron-deficiency anemia
- Associated with lupus erythematosus, rheumatoid arthritis, Crohn’s
disease, cancer, chronic kidney disease, HIV, Hep B and C
 CIRCULATORY DISORDERS STUDY NOTE - Alma Fuentes

- Genetic Blood disorders

- Thalassemia
- Defect in synthesis of normal hemoglobin- genetic disorder
- Mediterranean, African, Middle Eastern, southeast Asian
- Cooley’s Anemia-most severe
- *May have delayed wound healing
- Treatment may include regular blood transfusions, chelation,
folic acid supplements, bone marrow transplant
- CLINICAL CHARACTERISTICS
- Pale skin
- Pale nails
- Pale buccal mucosa
- Weakness, malaise, tired easily
- Dyspnea on slight exertion
- Spooning of nails

- IRON DEFICIENCY ANEMIA

- Number 1 type
- Hypochromic microcytic anemia
- Deficient hemoglobin (hypochromic)
- Small RBC (microcytic)
- Predilection for young
- Predilection for female
- Lab diagnosis
- SIGNS AND SYMPTOMS:
- Weakness
- Pallor
- Fatigue easily
- Decreased immune function
- Increased risk for infection
- Pallor of gingiva and mucosa
- Atrophic glossitis due to loss of filiform papillae
- Smooth and shiny (mod-severe anemia)
- Glossodynia (burning tongue/mouth)
- Secondary irritation to the thinned atrophic mucosa
- Smoking
- Mechanical trauma
- Hot or spicy foods

SICKLE CELL DISEASE

- Genetic
- Form of hemolytic anemia
- Results from a defective hemoglobin molecule
- Autosomal recessive
- Newborn screening mandatory
- Rarely show symptoms unless under severe stress
 CIRCULATORY DISORDERS STUDY NOTE - Alma Fuentes

- Life span of RBC is significantly reduced from 90-120 days to 10-15 days
- Onset of anemia within first six months of life
- Growth impaired
- Susceptibility to infection increased (pneumococcal)
- Death from vaso-occlusion resulting in infarction and organ damage and stroke
- Changes to blood vessels over time resulting from sickles damaging vessels and
organ damage including:
- Neurologic (impaired cognition and stroke)
- Lung function impaired
- Left ventricle dilates
- Heart murmurs
- Abnormal liver function
- Skeletal damage (need for joint replacements)
- Is episodic, often follows infection, and involves acute pain. Is unpredictable and
requires hospitalization

RDH CONSIDERATIONS

- Coarse trabecular pattern

- Osteoporotic changes
- Osteomyelitis of mandible
- Hypo-mineralization of teeth
- Malocclusion due to protrusion of maxilla (overgrowth of facial bones)
- Pale buccal mucosa
- Numb chin syndrome
- Facial and dental pain
- Comprehensive medical History-organ damage, joint replacement
- Understand characteristics of individual crises
- Must consult MD (risk of infection)
- May require antibiotic premedication
- Stress reduction
- Impeccable OH
- Anesthesia with low does of vasoconstrictors to avoid occlusion of vessels

WHITE BLOOD CELL DISORDERS

- Leukopenia - decrease in white blood cells (WBCs)
- Leukocytosis - increase in WBCs
- Caused by inflammatory and infectious states, trauma, exertion
- Most extreme cause of leukocytosis is leukemia
- Neutropenia
- Decrease in total of neutrophils
- Caused by defects in myeloid cells that may be genetic
- Secondary neutropenia may develop in those who have autoimmune
diseases (HIV/AIDS), alcohol abuse, folate or vitamin B12 deficiency,
infection or bone marrow transplant
 CIRCULATORY DISORDERS STUDY NOTE - Alma Fuentes

- SIGNS AND SYMPTOMS

- Stomatitis
- Enlarged lymph nodes
- Frequent infections such as pneumonia
- Lymphocytopenia
- Abnormally low number of lymphocytes in blood
- Acquired
- malnutrition, AIDS, chemotherapy, radiation, infection disease
(hepatitis, influenza, TB)
- Hereditary
- associated with inherited immunodeficiency disorders
- SIGNS AND SYMPTOMS:
- Pallor
- Bruising
- Mouth ulcers
- Leukemia
- malignant neoplastic disorder involving blood-forming cells (immature WBC)
- problem with progenitor cells
- excessive proliferation of white cells in immature state in the blood
- CAUSED BY MUTATIONS ON DNA
- ACUTE:
- COMMON IN CHILDREN
- sudden onset
- weakness/fatigue/pallor-anemia
- fever
- headache
- infection
- Bone pain
- hemorrhages on skin + mucous membranes-easy bruising
- caused by decrease in # of platelets- thrombocytopenia and
coagulation disorders
- enlargement of organs - spleen, liver
- bone + joint pain
- purpuric spots
- severe gingival enlargement - red, soft, spongy
- spontaneous bleeding
- similar to NUG (ulcerations, blunted papillae, necrosis, odour)
- classic symptoms plus
- toothache caused by invasion + necrosis of pulp
- mobility of teeth - breakdown of periodontal membrane +
supporting structures
- changes in mx + md alveolar bone

- CHRONIC:
- MIDDLE AGE AND OLDER - AVERAGE 72 YOA
- (exposed to radiation)
 CIRCULATORY DISORDERS STUDY NOTE - Alma Fuentes

- no cure
- chemotherapy may slow progress
- anemia, thrombocytopenia
- death 3 - 5 years
- DENTAL CARE
- tx only during remission
- multiple painful oral ulcers
- liable to secondary infections
- swab with antibacterial (ChX; + anti-fungal therapy)
- salt h20 or baking soda rinse
- inferior dental blocks contraindicated
- platelet count prior to extractions or extensive scaling
- susceptible to all infections often maintained on
prophylactic
- antibiotics
- meticulous cleaning of dental appliances / prosthesis
- fluoride rinses or gels-alcohol free?
- pit + fissure sealants
PLATELET DISORDER
- Thrombocytopenia Purpura
- abnormal subcutaneous bleeding in skin, mucous membranes + internal
organs
- Etiology
- Unknown origins
- Damage due to chemotherapy/radiation
- Virus
- Drugs such as hydrochlorothiazide , acetaminophen,
- HIV
- Hepatitis or blood transfusions
- Small hemorrhagic spots: petechiae
- larger purplish hemorrhagic spots: ecchymoses
- SYMPTOMS
- GI hemorrhages
- epistaxis (nosebleeds)
- hematuria (blood in urine)
- RDH CONSIDERATIONS
- Bleeding time-ensure controlled
- Avoid tissue trauma
- No ASA or Nsaids
- OHI
- Preventive care important

COAGULATION DISORDERS
- What to look for:
- Atrophy of papillae of tongue
- Glossodynia
 CIRCULATORY DISORDERS STUDY NOTE - Alma Fuentes

- Candidiasis
- Acute or chronic infections
- Severe ulcerations that do not heal normally
- Exaggerated gingival response to local irritants similar to NUG
- VON WILLEBRAND’S
- AKA (vascular hemophilia/angio hemophilia)
- hereditary congenital bleeding disorder-
- most common coagulation disorder in humans
- deficiency in clotting factor + platelet function
- von Willebrand factor (factor in clotting) does not work properly
- Platelets do not stick together to form clot
- No gender predilection
- large capillaries
- Defective platelets - do not adhere to one another
- Common in areas of many capillaries
- More common in Blood Type O
- FINDINGS:
- Bleeding of:
- gingiva
- nasal mucosa (increase in nose bleeds)
- GI tract
- prolonged bleeding following surgery or trauma
- Increase in bruising
-
RDH CONSIDERATIONS

Medical consultation
Treat with missing factor immediately before dental treatment if condition severe enough
Avoid trauma to tissues during scaling, radiography, or any other dental procedures
Clients with bleeding disorders may be at a high risk for caries and periodontal disease
Preventive TX: supplementary fluorides
Topical fluorides + BW’s should be at regular intervals
Fluorides
Sealants
Remin agents
Nutritional support (caries)
Sextant or quadrant therapy
Injections-infiltrations and intrapapillary injections OK-blocks require clotting factor
Impression trays-wax
No prescription of meds containing aspirin: gastric bleeding and thins blood
NSAIDs also contraindicated
If uncontrolled bleeding occurs stop treatment
If no clotting within a few minutes apply pressure to area with sterile gauze
Local hemostatic agents
Medical attention if unsuccessful