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Amy's Class Notes on Blood Disorders (1999)
I don't know if these will help you out but just in case, I added them onto the site.  These are just notes that I took in class in different formats.

Blood Disorders -- Oral Conditions

1. Petechiae -- increase due to bleeding
2. Increased bleeding
3. Increased Susceptibility to infection -- important to plaque control
4. Longer Healing Time
5. Increased Candida Infections -- fungal infections.

Blood Disorders -- Characteristics

1. Soft tissue changes in mouth
2. Type of anemia, paleness in tissue
3. Lower immunity to infection
4. Increased Bleeding

Leukemia

• Malignant neoplasms (new growth), cancer of leukocytes.
• Large numbers of White blood cells.
• Acute:
  **fatigue, pallor, weakness (from anemia)
  **purpura and ecchymoses of the skin, bleeding from the nose and gingiva (from thrombocytopenia)
  **Increased bacterial infection (fever)
  **headache, nausea, vomiting, and sometimes seizures and coma (from leukemic infiltration of the meninges)
• Chronic:
  **low-grade fever, night sweats
  **weight loss, weakness, easy fatigability
  **Anemia with exertional dyspnea
  **lymphadenopathy, splenomegally, hepatomegaly

Dental signs and symptoms

1. Enlarged lymph nodes
2. Anemia
3. Tendency to bleed
   **Ecchymoses (bruising)
   **Petechiae
4. Candidiasis infections
5. May develop osteoporosis
6. Gingival lesions
   **grossly enlarged
   **Blueish-red
   **Soft, spongy
   **Bleeding

Normal Tx.

• Chemotherapy, radiation, bone marrow transplants

Dental Tx.

MD Consult: Yes

Pre-med: Most yes (susceptible to infection, therapies, are immunosupressant
        **Very high level of asepsis
        **may have had transfusions

Modifications:

• Address gingival enlargement with pallative tx.
• Severe gingival enlargement
  **Removal of plaque -- soft toothbrush
  **Warm rinses
• Cannot scaled until MD approval
• After tx. emphasis on controlled bleeding
  **No hot foods for 24 hours
  **Soft food for 24 hours
  **no smoking, aspirins, straws
• Healing time 2-3x longer
• Nystatin rinse (candidiasis)

Hemophelia

Types

1. Hemo A

2. Hemo B (Christmas disease -- males)

3. Von Willebrands Disease

• Hemophelia -- congenital disorder affects blood clot disorders

• bleed easily from minor trauma

• can bleed into joints or muscles (hemathroses)

• joint deformity and crippling

• intramuscular hemorrhage

• can have oral bleeding
  **Reduce gingivitis
  **might have fear of bleeding, so pt. may not brush or floss

• Treatments used:
  **may be given clotting factor
  **Home infusion program

Dental hygiene tx.

Consult: Yes
        **May want to know type
        **Have MD clearance
        **May be given clotting factor

Pre-med: Yes, (very prone to infection)

	Increased plaque control
	show correct way to floss to avoid floss cuts
	soft toothbrush
	instruct parents if pt. is a child on proper homecare
	Preventive dentistry is extremely important: **fluoride **sealants **plaque control (patient ed.) **nutritional counseling
	Change instruments **Start suprag first **do small segments/sections **evaluate healing before subgingival scaling **probing and charting     --not until healthy

Suggestions:

• avoid rubber dam
• film placement of radiographs (be careful)
• beading wax with impressions
• use high speed suction very carefully
  **can cause a hematoma
• apply perio pac to reduce bleeding
• if develops a hematoma, apply ice pack.  Call MD.  Tell patient not to use aspirin
• Frequent recalls

Anemia

• Reduction of the hemoglobin concentration, the hemacrit, or the number of red blood cells to a level below that which is normal for the individual.  As a result of the anemia, oxygen-carrying capacity to the cells is diminished.  Oxygen is essential in all body tissues for normal maintenance

• Iron deficiency anemia is a hypochromic microcytic anemia, which means that the hemoglobin is deficient (hypochromic) adn the red blood corpuscles are smaller than normal and deficient in hemoglobin (microcytic). In general, it is found more in younger that in older people, and more in females than in males.

• Megaloblastic anemias:
  **pernicious anemia -- B12 deficiency
  **Foliate deficiency anemia -- deficient of folate or folic acid.
  **megaloblastic anemias are characterized by abnormally large (megalo-) red blood cells, many of which are oval shaped.  The two principal types of megaloblastic anemias are pernicious anemia and foliate deficiency anemia.

• Sickle cell anemia -- hereditary form of hemolytic anemia, resulting from a defective hemoglobin molecule.

Signs and symptoms:

• pale and thick skin
• weakness, malaise, easy fatigability
• dyspnea on slight exertion, faintness
• headache, vertigo, tinnitus
• dimness of vision, spots before the eyes
• brittle nails with loss of convexity
• Sickle Cell Anemia:
  **impaired growth and development
  **children prone to communicable diseases

Treatments used:

• Iron deficiency -- oral ferrous iron tablets
• Foliate deficiency -- increase in folic acid
• Pernicious deficiency -- synthetic B12
• Sickle cell --
  **Preventive procedures -- folate supplements to cope with increased need by bone marrow
  **treatment for disease states

Dental Hygiene Tx.

MD Consult: Anemia - NO Sickle Cell: Yes

Pre-med: Anemia: NO Sickle Cell: yes (high level of asepsis)

Anemia:

Signs and symptoms:

• glossitis
• papillary atrophy
• glossodynia

Sickle Cell Anemia:

Signs and symptoms:

• enamel hypoplasia with delayed eruption
• increased radiolucency on radiograph (alveolar bone)
• very coarse trabecular bone pattern
• signficant alveolar bone loss
• may see perio in children
• soft, pale color
• may be jaundice

Dental Hygiene Tx and modifications:

• Provide care without precipitating a sickle cell crisis
• no vasoconstrictors due to impaired circulation
•  no aspirin
• cannot scale until MD approval
• increased plaque control
• reduce stress
• hematocrit and hemoglobin determination

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