Oral Manifestations of Haematological Disorders

Introduction

1. Define haematological disorders.

Diseases or disorders of blood and blood-forming organs are known as haematological disorders. Most of the haematological disorders show oral manifestations.

2. Why should we know about the oral manifestations of haematological disorders?

Oral manifestations of haematological diseases pave the way to diagnose the condition earlier. A haematological disorder causes petechiae or ecchymosis with gingival bleeding in the oral cavity. For example, anaemia shows pale oral mucosa and ulcers as its oral manifestation and leukaemia shows gingival overgrowth as its oral manifestation.

Anaemia

Anaemia is a condition in which there is a decrease in blood cell count in the body. The decrease in the blood cell count causes fatigue and dizziness.

Types of Anaemia

Different types of anaemia include Microcytic anaemia, Normocytic anaemia and Macrocytic anaemia.

• Iron deficiency anaemia, Sideroblastic anaemia and Thalasemia are the conditions in Microcytic anaemia.

• Hemolytic anaemia and Aplastic anaemia are the conditions in Normocytic anaemia.

• Megaloblastic anaemia and Nonmegaloblastic anaemia are the conditions in Macrocytic anaemia.

Oral manifestations of Anaemia

Oral Manifestations of Iron deficiency anaemia

Most common oral manifestations of Iron deficiency anaemia are oral mucosal atrophy, atrophic glossitis and angular cheilitis. Oral mucosal atrophy is due to thinning of the oral mucous membrane. Atrophic glossitis in simple terms is inflammation of the tongue. Angular cheilitis is the presence of scales in the corners of the mouth and lips.

Oral Manifestations of Thrombocytopenia

Thrombocytopenia is a condition in which there is decrease in production of platelets or increase in destruction of platelets. Thrombocytopenia is serious when the platelet count falls below 30000 per cubic mm. 

Presence of petechiae and hemorrhagic blisters in oral mucosa cause spontaneous bleeding due to intracranial haemorrhage and ecchymosis are oral manifestation of Thrombocytopenia.

Oral manifestations of Polycythemia vera

Polycythemia vera is a blood disorder. The RBC count of 6 to 12 million with concentration of haemoglobin upto 18 -24 g/dl increases the blood viscosity in patients with polycythemia vera. 

Purplish discolouration of oral mucosa and tongue, keratosis, ulcers in oral mucosa, and gingival enlargement are some of the oral manifestations of Polycythemia vera.

Oral manifestations of Aplastic Anaemia

Aplastic anaemia is diagnosed based on the platelet cloud which would be <25 × 10 to the power of 9 /L. Candidiasis and oral ulcers are common manifestations of hematologic diseases.

Oral manifestations of Von Willebrand Disease

Von Willebrand diseases occur in 1% of the population due to defects in the von Willebrand factor. It is characterised by abnormalities in platelet adhesion. In severe deficiency of von Willebrand factor, it shows oral manifestations such as gingival bleeding, gingival enlargement, and dental extractions which may cause excessive bleeding than normal bleeding time.

Oral manifestations of Sickle cell disease

As the name indicates, sickle cell disease is a condition in which the RBCs are sickle shaped due to the abnormal production of hemoglobin S. Some oral manifestations of sickle cell disease are pulpal necrosis, enamel hypomineralisation. Step ladder pattern is the characteristic radiographic appearance seen due to dentofacial abnormalities. 

Oral manifestations of Thalassemia

Thalasemia is a condition in which there is defect in production of polypeptide chain in haemoglobin. ‘Chipmunk face’ is the characteristic feature of Thalasemia. Oral manifestation of Thalasemia include maxillary enlargement leading to spacing of teeth in maxilla causing malocclusion and prominent maxillary molar eminence. 

Management of Haematological disorders

Chemotherapy, Haematopoietic stem cell transplant and Radiotherapy are the different treatment options for treating malignant Haematological diseases. Dental management of haematological diseases includes using hemostats to reduce bleeding during dental procedures and using adrenaline-free local anaesthetics can help decrease the chances of profuse bleeding during the procedure.

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