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Bhavyaa R, Vignesh KC, Muthu MS, Haridoss S, Abirami S. Glanzmann Thrombasthenia: Use of the Soft Splint with Tranexamic Acid Paste to Reduce Spontaneous Oral Bleeding. Int J Clin Pediatr Dent 2021; 14:580-585. [PMID: 34824518 PMCID: PMC8585906 DOI: 10.5005/jp-journals-10005-1973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Glanzmann thrombasthenia is a rare bleeding disorder due to defects in the glycoprotein Ilb/IIIa complex present on the platelet membrane. The most common mode of treatment for this disorder is platelet transfusion. However, scientific evidence does state that repeated transfusions could lead to auto immunization making transfusions ineffective. Aim and objective To describe the use of a novel technique of soft splint with tranexamic acid paste to stop oral bleeding in a patient with Glanzmann thrombasthenia (GT). Case description A 7-year-old female patient with a known history of GT was referred to the pediatric department. The chief complaint of the patient revealed a history of spontaneous bleeding from the oral cavity. The patient required multiple teeth extractions due to severely carious teeth. History revealed that the patient was admitted to the hospital (casualty) three times within 1 month due to a similar complaint leading to hypovolemic shock. Several transfusion procedures were done to stop the spontaneous bleeding. To stop the intraoral bleeding without transfusions, a novel method of using a soft splint with tranexamic acid paste (500 mg tablet crushed and mixed with saline) in the area of spontaneous bleeding was employed with a successful follow-up of 7 months. Conclusion Soft splint with the tranexamic acid paste can serve as an effective method of treatment for patients with spontaneous oral bleeding due to medical conditions like GT. Clinical relevance This case report highlights the need for awareness among all the healthcare providers about the importance of regular dental visits. The healthcare providers also need to emphasize the same to all patients with medical conditions to avoid such life-threatening situations. How to cite this article Bhavyaa R, Vignesh KC, Muthu MS, et al. Glanzmann Thrombasthenia: Use of the Soft Splint with Tranexamic Acid Paste to Reduce Spontaneous Oral Bleeding. Int J Clin Pediatr Dent 2021;14(4):580–585.
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Affiliation(s)
- R Bhavyaa
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - K C Vignesh
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - M S Muthu
- Centre for Early Childhood Caries Research (CECCRe), Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India; Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Selvakumar Haridoss
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - S Abirami
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Karasneh J, Christoforou J, Walker JS, Dios PD, Lockhart PB, Patton LL. World Workshop on Oral Medicine VII: Bleeding control interventions for invasive dental procedures in patients with inherited functional platelet disorders: A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:412-431. [PMID: 34758941 DOI: 10.1016/j.oooo.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The objective of this study was to determine bleeding control interventions (BCIs) that were reported to be effective in controlling postoperative bleeding in patients with inherited functional platelet disorders (IFPDs) undergoing invasive dental procedures. STUDY DESIGN We searched MEDLINE/PubMed, Embase, Cochrane Library (Wiley), and Scopus from 1960 through April 2020 for studies on patients with IFPD undergoing invasive dental procedures. Two reviewers conducted assessments independently. RESULTS We found a total of 620 nonduplicate published articles, of which 32 studies met our inclusion criteria. Management with BCI in patients with IFPD included in this systematic review was effective in 80.7% of treatment sessions. Local measures used intraoperatively were found to be effective. Three different protocols of BCI were noted; the most effective protocol consisted of antifibrinolytics, scaffold/matrix agents, and sutures (P < .01). An adjunct protocol consisting of a tissue sealant was also effective (P < .01). A third protocol of platelet transfusion and antifibrinolytics was ineffective in controlling postoperative bleeding in 4 of 6 dental sessions. CONCLUSIONS This systematic review supports the use of local measures intraoperatively and antifibrinolytics postoperatively. It also supports making decision regarding platelet transfusion based on the clinician's clinical judgment and medical history of the individual patient.
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Affiliation(s)
- Jumana Karasneh
- Department of Oral Medicine and Oral Surgery; School of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
| | - Janina Christoforou
- Faculty of Health and Medical Sciences, Dental School, University of Western Australia, Perth, Australia
| | - Jennifer S Walker
- Health Sciences Library, University of North Carolina at Chapel Hill, NC, USA
| | - Pedro Diz Dios
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Peter B Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - Lauren L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, NC, USA
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Glanzmann's Thrombastenia: The Role of Tranexamic Acid in Oral Surgery. Case Rep Dent 2018; 2018:9370212. [PMID: 30254767 PMCID: PMC6145161 DOI: 10.1155/2018/9370212] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/04/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Abstract
Glanzmann's thrombastenia (GT) is the most frequent inherited condition. GT is a genetic autosomal recessive disease caused by the alteration of the genes ITGA2B and ITGB3, located on the chromosome 17. The incidence of GT is calculated in 1 on 1000000. The patients, during their life, show episodes of mucocutaneous bleeding, epistaxis, and gingival bleeding. Some subjects required continuous bleeding transfusion. The aim of this case report is to demonstrate that oral assumption of tranexamic acid is a gold standard to prevent excessive bleeding. The patient GM of 36 years old with GT type 1 needs dental extractions of the teeth 4.7 and 4.8 at the "Tor Vergata" University Hospital in Rome. The specialist suggests that 3 days before surgery, the patient must take 6 vials every day of tranexamic acid that is used in obstetrics and gynecology. The teeth were extracted and applied suture. The patient is observed and is recommended mouth rinse with tranexamic acid. No bleeding complications were observed.
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Surgical procedures in patients with Glanzmann's thrombasthenia: case series and literature review. Blood Coagul Fibrinolysis 2017; 28:171-175. [PMID: 27273143 DOI: 10.1097/mbc.0000000000000524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Glanzmann's thrombasthenia is a rare platelet function disorder with an autosomal recessive pattern of inheritance. Achieving haemostasis in such patients who undergo surgical procedures always poses a significant challenge. Herein we report six cases of Glanzmann's thrombasthenia, who underwent nine surgeries under the cover of platelet-rich concentrates with or without recombinant activated factor VII . Of these, five were major surgeries such as thyroidectomy, laparotomy, Hartmann's procedure, reversal of Hartmann's procedure and a complete dental extraction. All five procedures were successfully done without any major bleeding. The major cost incurred in these procedures is due to the large number of blood products used and recombinant activated factor VII if used.
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Ghosh A, Kumar S, Chacko R, Charlu AP. Total Extraction as a Treatment for Anaemia in a Patient of Glanzmann's Thrombasthenia with Chronic Gingival Bleed: Case Report. J Clin Diagn Res 2016; 10:ZD11-2. [PMID: 26894187 DOI: 10.7860/jcdr/2016/16383.7123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/02/2015] [Indexed: 11/24/2022]
Abstract
Glanzmann's Thrombasthenia (GT) is a rare autosomal recessive bleeding disorder affecting the megakaryocyte lineage and is characterized by lack of platelet aggregation on stimulation. The molecular basis is linked to quantitative and qualitative abnormalities of αIIbβ3 integrin. Most of the patients with severe Glanzmann's thrombasthenia have spontaneous gum bleeding and persistent low haemoglobin levels. Often these patients are addressed with local haemostatic measures and platelet coverage. We report a case of a severe Glanzmann's thrombasthenia with chronic gingivitis and associated spontaneous gum bleed with chronic low haemoglobin levels, managed subsequently with total dental extraction under appropriate platelet and recombinant factor VIIa coverage. Further follow up of the patient substantiated the treatment protocol with increased and stable haemoglobin levels, thus emphasizing the need for total dental extraction in patients with severe Glanzmann's with chronic spontaneous gum bleed, as a definitive treatment option, which has not been reported so far in the literature.
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Affiliation(s)
- Abhishek Ghosh
- Fellow, Head and Neck Oncology, HCG Cancer Centre , (Previously Fellow at CMC Vellore), Ahmedabad, India
| | - Saurabh Kumar
- Assistant Professor, Department of Oral and Maxillofaical Surgery, Christian Medical College and Hospital , Vellore, Tamil Nadu, India
| | - Rabin Chacko
- Head of Department Unit I, Department of Oral and Maxillofacial Surgery, Christian Medical College and Hospital , Vellore, Tamil Nadu, India
| | - Arun Paul Charlu
- Associate Professor, Department of Oral and Maxillofacial Surgery, Christian Medical College and Hospital , Vellore, Tamil Nadu, India
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Khan S, Zia A, Gupta ND, Bey A. Acute gingival bleeding as a complication of falciparum malaria: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:e19-22. [PMID: 22668636 DOI: 10.1016/j.oooo.2011.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 10/09/2011] [Accepted: 10/24/2011] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Acute gingival bleeding can occasionally be the only sign of systemic bleeding problems. The diagnosis and management of such conditions may challenge the skills of the dentist. CASE REPORT The present report describes a case of severe, prolonged gingival bleeding in a 54-year-old woman as a consequence of Plasmodium falciparum malaria infection. Specific highlights are focused on the management of the patient with emphasis on early diagnosis of the disease so as to improve the prognosis. This case report also stresses that medical intervention to correct the underlying aberration of hemostasis is necessary for local dental measures to successfully stop bleeding. CONCLUSIONS Acute gingival bleeding as a complication of systemic disease can be challenging to manage unless the underlying systemic cause is diagnosed. Therefore, the dentist must be aware of various systemic conditions that can lead to gingival bleeding. The present case report describes a patient with acute gingival bleeding secondary to Plasmodium falciparum infection.
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Affiliation(s)
- Saif Khan
- Department of Periodontology, Dr. Z A Dental College, Aligarh Muslim University, India
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Mehta DN, Bhatia R. Dental Considerations in the Management of Glanzmann's Thrombasthenia. Int J Clin Pediatr Dent 2010; 3:51-6. [PMID: 27625557 PMCID: PMC4955045 DOI: 10.5005/jp-journals-10005-1054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 10/12/2009] [Indexed: 11/23/2022] Open
Abstract
Glanzmann's thrombasthenia, is one of the rarest congenital, genetically inherited platelet disorder. It has an incidence of about 1:1,000,000, but is more common in populations with increased consanguinity. Glanzmann's thrombasthenia is characterized by deficiency or dysfunction of glycoprotein (GP) lib and Ilia, which are the receptors of fibrinogen. Both sexes are equally affected. Typical mucocutaneous bleeding occurs at birth or early infancy. Obtaining appropriate dental history of excessive bleeding after dental extraction, unexplained spontaneous mucocutaneous bleeding, gingival bleeding during teething or shedding of deciduous teeth and petechiae, ecchymoses or purpura on mucous membranes can play an important part in diagnosis. Hence, the pediatric dentist plays a very crucial role for prompt diagnosis and management of Glanzmann's thrombasthenia. Presenting here is a known case of Glanzmann's thrombasthenia, of a 6-year-old girl who required to undergo dental extraction and its successful management using an "acrylic-splint" along with the placement of "Calgigraf-Ag Foam".
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Affiliation(s)
- Diana N Mehta
- Postgraduate Student, Department of Pediatric and Preventive Dentistry, Padmashree Dr. DY Patil Dental College and Hospital Navi Mumbai, Maharashtra, India
| | - Rupinder Bhatia
- Professor and Head, Department of Pediatric and Preventive Dentistry, Padmashree Dr. DY Patil Dental College and Hospital Navi Mumbai, Maharashtra, India
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Tosetto A, Balduini CL, Cattaneo M, De Candia E, Mariani G, Molinari AC, Rossi E, Siragusa S. Management of bleeding and of invasive procedures in patients with platelet disorders and/or thrombocytopenia: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res 2009; 124:e13-8. [PMID: 19631969 DOI: 10.1016/j.thromres.2009.06.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 06/11/2009] [Accepted: 06/14/2009] [Indexed: 10/20/2022]
Abstract
The optimal management of bleeding or its prophylaxis in patients with disorders of platelet count or function is controversial. The bleeding diathesis of these patients is usually mild to moderate: therefore, transfusion of platelet concentrates may be inappropriate, as potential adverse effects might outweigh its benefit. The availability of several anti-hemorrhagic drugs further compounds this problem, mainly because the efficacy/suitability of the various treatment options in different clinical manifestations is not well defined. In these guidelines, promoted by the Italian Society for Studies on Haemostasis and Thrombosis (Società Italiana per lo Studio dell'Emostasi e della Trombosi [SISET]), we aim at offering the best available evidence to help the physicians involved in the management of patients with disorders of platelet count or function. Literature review and appraisal of available evidence are discussed for different clinical settings and for different available treatments, including platelet concentrates (PC), recombinant activated factor VII, desmopressin, antifibrinolytics, aprotinin and local hemostatic agents.
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Affiliation(s)
- A Tosetto
- Clinica Medica III, Università di Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia.
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Yadalam U, Kranti K, Seshan H. Periodontal considerations for Glanzmann's thrombasthenic patient. J Indian Soc Periodontol 2008; 12:26-7. [PMID: 20142940 PMCID: PMC2813551 DOI: 10.4103/0972-124x.44095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 11/04/2008] [Indexed: 11/04/2022] Open
Abstract
Glanzmann's thrombasthenia (GT) was reported and described as a bleeding diathesis seen in children and characterized by diminished clot retraction. The disorder is caused by a deficiency in the platelet membrane glycoprotein IIb-IIIa complex, with bleeding due to defective platelet hemostatic plug formation. The recurrent features of GT include purpura, epistaxis, gingival hemorrhage, and menorrhagia. GT being an autosomal recessive trait is reported to be especially prevalent in populations where intermarriage is common. Typically, the patients are diagnosed in infancy within the age of five. Though no differences appear to occur based on sex men more frequently present with gingival bleeding. We report the case of a female patient with GT who presented with the chief complaint of gingival bleeding. The patient was given periodontal treatment under platelet transfusion followed by proper oral hygiene instructions. The report discusses periodontal consideration for GT patients.
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Affiliation(s)
- Umesh Yadalam
- Ex-Postgraduate Student, Department of Periodontics, M.S. Ramaiah Dental College and Hospital, MSRIT Post, Bangalore - 560 054, India
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Toygar HU, Guzeldemir E. Excessive Gingival Bleeding in Two Patients With Glanzmann Thrombasthenia. J Periodontol 2007; 78:1154-8. [PMID: 17539731 DOI: 10.1902/jop.2007.060393] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Glanzmann thrombasthenia (GT) is an exceedingly rare but well-defined inherited disorder of platelet function caused by a defect in the glycoprotein IIb/IIIa complex. The association of GT with consanguinity has been noted, especially in geographic regions in which intermarriage is common. In most patients, GT is diagnosed during early infancy or before the age of 5 years. Common manifestations of this disorder are gingival hemorrhage, purpura, epistaxis, petechiae, and menorrhagia. Chronic, prolonged, untreated, or unsuccessfully treated bleeding may be life threatening. METHODS We report two female patients with GT who were referred by our hematology clinic to our periodontology department for the treatment of excessive gingival bleeding. The first patient was treated with a platelet transfusion and underwent periodontal therapy (scaling and root planing and dental polishing). The second patient, whose GT was undiagnosed at the time of her referral to our department, applied to our emergency service because of uncontrolled gingival bleeding that developed after scaling and root planing was performed by her dentist. Both patients had been called for regular dental visits. RESULTS All treated sites healed without complications. The first patient was monitored for 2 years, during which she practiced proper oral hygiene and experienced no periodontal complications. The other patient did not participate in follow-up. CONCLUSIONS Gingival bleeding is usually the first sign of most hematologic disorders, and dentists must be alert for the signs of unusual gingival bleeding. In such cases, collaboration with a hematologist is essential. Under the proper circumstances, periodontal treatment can be performed with an acceptable outcome. With proper oral hygiene, we believe that there will be no complications and no gingival bleeding.
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Affiliation(s)
- Hilal Uslu Toygar
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey.
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Poon MC, d'Oiron R, Hann I, Négrier C, de Lumley L, Thomas A, Karafoulidou A, Demers C, Street A, Huth-Kühne A, Petrini P, Fressinaud E, Morfini M, Tengborn L, Marquès-Verdier A, Musso R, Devecioglu O, Houston DS, Lethagen S, Van Geet C, von Depka M, Berger C, Beurrier P, Britton HA, Gerrits W, Guthner C, Kuhle S, Lorenzo JJ, Makris PE, Nohe N, Paugy P, Pautard B, Torchet MF, Trillot N, Vicariot M, Wilde J, Winter M, Chambost H, Ingerslev J, Peters M, Strauss G. Use of recombinant factor VIIa (NovoSeven) in patients with Glanzmann thrombasthenia. Semin Hematol 2001; 38:21-5. [PMID: 11735106 DOI: 10.1016/s0037-1963(01)90143-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recombinant factor VIIa (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) appears effective and relatively safe for the treatment of bleeding and for surgical prophylaxis in patients with Glanzmann thrombasthenia as reported to the International Registry on rFVIIa and Congenital Platelet Disorders. One of the shortcomings of the Registry data is the heterogeneity of treatment protocol, including dosage, number of doses used, duration of treatment before declaration of failure, and mode of rFVIIa administration (bolus v continuous infusion). The data are not yet sufficient to define optimal regimens for various indications such as the type of bleeding or the type of procedures. The place of this drug compared to platelet transfusion in the overall management of patients with Glanzmann thrombasthenia will need to be determined in relationship to a number of challenges and unresolved issues in the clinical care of these patients. These issues include: how to improve local measures for patients with mucosal bleeds, optimal management of young women during menarche, optimal platelet transfusion regimens for various indications, the relationship between antiplatelet antibodies detected by monoclonal antibody-specific immobilization of platelet antigens (MAIPA) and effectiveness of platelet transfusion, whether there are other biological tests that may correlate with effectiveness of platelet transfusion, and management of pregnancy and delivery regarding antiplatelet immunization.
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Affiliation(s)
- M C Poon
- Hemophilia/Hemostasis Centres in Canada.
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Porter SR. Gingival and periodontal aspects of diseases of the blood and blood-forming organs and malignancy. Periodontol 2000 1998; 18:102-10. [PMID: 10200716 DOI: 10.1111/j.1600-0757.1998.tb00142.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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