A closer look at Blood Disorders

What is Neutropenia?

If you have neutropenia then you will have low levels of white blood cells. This is called neutrophils. The white blood cells are the first line of defence against bacteria. Neutropenia can be caused by medicines that get in the way with how these cells are produced by the bone marrow. HIV or AIDS can also cause neutropenia.

If you have neutropenia then you are more likely to get infections in your mouth. The problem is that you may not even notice the signs of infection. Neutrophils cause redness and swelling. These are signs of infection and if there are not enough neutrophils, there won't be any redness or swelling at all. Moreover, infections like periodontal gum disease, yeast infections, and oral ulcers can get worse very quickly in a person with neutropenia. People with severe neutropenia will have deep ulcers in their mouths which are usually painful.

What does the dentist do about neutropenia?

If you have neutropenia then you will be given antibiotics prior to any major dental treatment. This will help protect you from infections. The normal neutrophil count is from 3,000 to 5,000 cells and if your neutrophil count falls below 1,000, you will certainly need antibiotics. You may even have to take antibiotics for several days before the treatment. If you have neutropenia or if you are taking medicines that cause neutropenis then you must provide you dentist with a copy of your latest blood test results.

What is polycythemia vera?

Polycythemia is characterized by too many red blood cells. If you have too many red blood cells then your blood is more likely to clot than the normal person. You can have purplish or red areas on your tongue, cheeks, lips, and gums.

This condition can happen by itself or it can happen when your body responds to a lack of oxygen. Heavy smokers, people with emphysema, or people who move to very high altitudes may get polycythemia.

Those with polycythemia should see a dentist who specializes in treating people with other related medical conditions. This will help reduce the risk of bleeding and the risk of your blood clotting. Your dentist may want you to go through a blood test before you go through treatment. If the tests are not normal then your dentist will communicate with your physician before any treatment is done.

What is anemia?

Anemia is characterized by a lack of haemoglobin in the blood. Haemoglobin carries oxygen in your blood and it distributes oxygen to several parts of your body. Anemia may be caused by

a loss of blood
an overload in fluids
an increased destruction of red blood cells
a decrease in the production of red blood cells
deficiencies in your nutrition
defects in your haemoglobin molecules

There are several types of anemia also. They are

iron deficiency anemia
aplastic anemia
sickle cell anemia
pernicious anemia
thalassemia

People with anemia have mouths that look pale inside. Their tongues may also look smooth. Some X-rays will even show changes in the jawbone.

How will your dentist treat anemia?

People with certain types of anemia like aplastic anemia are at a higher risk for infection. Your dentist may provide you with antibiotic mouth rise, antibiotic pills, or even both. You should take these before a dental procedure or before any major dental treatment. These are designed so that you reduce the risk of uncontrolled bleeding. These drugs are known as antifibrinolytic drugs. During the treatment, your dentist will avoid certain types of injections so that bleeding problems will not occur.

If you have sickle cell anemia then you should get your teeth cleaned during non-crisis periods. You should keep your appointments short as well. Consider getting a blood test before any dental treatment like a filling or a root canal. Your dentist will review the results of the blood test and assess if you can go through the procedure.

If you have chronic anemia like thalassemia then you may heal very slowly. For those with chronic anemia, a talk with your dentist is required. Your dentist may need to do some special procedures or take certain precautions. This disease will affect your blood count so make sure that you show your dentist a copy of your blood test results before going through any procedure. You may have to get extra oxygen in order to breathe during these dental treatments.

What is hemophilia?

People with hemophilia are lacking essential proteins that allow your blood to clot. If you have hemophilia then your mouth may bleed very often. You should try not to brush and floss too often because this will make your mouth bleed. Due to this, you may be at risk for more dental problems than most healthy people.

What will your dentist do about hemophilia?

Before going through any dental treatment that involves bleeding, hemophiliacs may need extra blood products. It will increase the amount of clotting in the blood. If you need blood products or proteins for dental procedures then you may have to get treated in a hospital. There are people who can administer the products by themselves though. You should talk to your doctor or your dentist about your condition prior to any treatment. The tests will show the levels of blood proteins and they will also show if you are at risk for uncontrollable bleeding.

If you have hemophilia then your dentist may not give you anaesthetic shots called block injections. In some cases, this type of injection may cause swelling or bruising under the skin. This condition is called a haematoma. If you need extensive dental surgery then you may need to go to a hospital for your treatment. You may have to use an operating room and you will be given general anaesthesia.

There are some cases where procedures are generally safe and these procedures are

having fillings or crowns
getting a root canal treatment
getting fitted for dentures or having dentures refitted or relined
orthodontia without getting sharp brackets or wires

You dentist will do their best to minimize any bleeding. People with braces should avoid getting cut from the wires, brackets, and bands. There are experts who say that it is better to have orthodontic appliances attached to your mouth instead of the ones that you can take out of your mouth. In these cases, you may need an immediate follow-up appointment with your dentist. The objective is to decrease the chances of bleeding.

Oral surgery poses the greatest risk of severe bleeding and it should only be done if necessary. You and your dentist must take the necessary precautions. You may even have to ask the help of a physician or a haematologist. Your dentist will use medicines and surgical techniques to lessen the amount of bleeding. You must

replace missing blood-clotting factors from 50% to 100% of normal levels prior to the surgery
replace blood clotting factors after the surgery if needed
after your surgery, you should also consider taking medicines that prevent blood clots from breaking down
have a lot of soft foods in your diet

What are platelet disorders?

Platelets help the blood clot. Without enough platelets, your blood will not clot well. There can be uncontrolled bleeding. Two of the most familiar platelet disorders are idiopathic thrombocytopenia purpura and thrombotic thrombocytopenia purpura. People with platelet disorders worry about bleeding gums after brushing. Since they don't brush enough, they may be at a greater risk of cavities and gum disease.

What will your dentist do about platelet disorders?

Before every dental visit, you should provide your dentist with your latest blood test results. The normal platelet count is between one hundred fifty thousand and four hundred thousand cells. People with platelet levels fewer than two hundred thousand are at a risk of uncontrolled bleeding. They should have dental treatment in a hospital that is capable of platelet transfusion to patients. Moreover, if your platelet levels are between twenty thousand and fifty thousand then you should be treated by a dental specialist trained in hospital dentistry, oral medicine, or oral surgery. Special surgical techniques and products are required so that the risk of uncontrolled bleeding is reduced. Again, you may also need platelet infusion.

If your platelet levels are above fifty thousand then most treatments are usually safe. If you experience any discomfort then you should take aspirin or nonsteroidal anti-inflammatory drugs or NSAIDs. Examples of NSAIDs are ibuprofen, Advil, and Motrin. These drugs will make difficult for the blood to clot. Moreover, your dentist must be careful when a block injection is given. A local anaesthetic in your lower jaw may result in swelling or bruising under the skin. This is also known as a haematoma.

People with braces must avoid cuts from brackets, wires, and bands. Experts say that it is generally better to have fixed orthodontic appliances than those that can be removed from your mouth. In these cases, you need to have close follow-up visits with your dentist so that the chances of any bleeding are reduced.