Gingival hemorrhage, myelodysplastic syndromes, and acute myeloid leukemia. A case report

Association between oral health-related quality of life and periodontal status in patients with leukemia

OBJECTIVE

The aim was to evaluate the association between oral health-related quality of life (OHRQol) and periodontal status in patients with leukemia.

METHODS

A total of 55 patients with leukemia (42.09 ± 16.57 years, 27.3% females) answered the Oral Health Impact Profile, short version (OHIP-14) and underwent a periodontal examination. Associations between periodontal status and total mean OHIP-14 scores were analysed, and the prevalence of high scores was identified for each group.

RESULTS

A total mean OHIP-14 score of 13.18 was observed for the entire sample. The corresponding total mean OHIP-14 scores for patients with moderate (n = 18), absent/mild (n = 24), and severe periodontitis (n = 13) were 17.11, 12.50, and 9.00 (P = 0.061), respectively. A higher prevalence of high scores was found for the 'feeling ill-at-ease' question (psychological discomfort domain) for absent/mild and moderate periodontitis patients, whereas those with severe periodontitis had higher prevalence on the 'feeling embarrassed' question (psychosocial disability domain). In the adjusted analysis, hospitalisation was associated with higher OHIP-14 scores (β = 8.49; 95% CI 1.89-15.08; P = 0.013). Higher OHIP-14 scores were not significantly associated with either patients presenting >15% sites with gingival bleeding or those with moderate/severe periodontitis.

CONCLUSION

Leukemia was associated with a negative influence on OHRQoL. However, this association was better explained by the patient's systemic condition than by an impact of its periodontal condition. Nonetheless, patients with leukemia presented with gingivitis and/or periodontitis, pointing to the need for oral health care for these individuals.

Dental plaque-induced gingival conditions

OBJECTIVE

This review proposes revisions to the current classification system for gingival diseases and provides a rationale for how it differs from the 1999 classification system.

IMPORTANCE

Gingival inflammation in response to bacterial plaque accumulation (microbial biofilms) is considered the key risk factor for the onset of periodontitis. Thus, control of gingival inflammation is essential for the primary prevention of periodontitis.

FINDINGS

The clinical characteristics common to dental plaque-induced inflammatory gingival conditions include: a) clinical signs and symptoms of inflammation that are confined to the gingiva: b) reversibility of the inflammation by removing or disrupting the biofilm; c) the presence of a high bacterial plaque burden to initiate the inflammation; d) systemic modifying factors (e.g., hormones, systemic disorders, drugs) which can alter the severity of the plaque-induced inflammation and; e) stable (i.e., non-changing) attachment levels on a periodontium which may or may not have experienced a loss of attachment or alveolar bone. The simplified taxonomy of gingival conditions includes: 1) introduction of the term "incipient gingivitis;" 2) a description of the extent and severity of gingival inflammation; 3) a description of the extent and severity of gingival enlargement and; 4) a reduction of categories in the dental plaque-induced gingival disease taxonomy.

CONCLUSIONS

Dental plaque-induced gingival inflammation is modified by various systemic and oral factors. The appropriate intervention is crucial for the prevention of periodontitis.

Severe Gingival Bleeding in a Myelodysplastic Patient: Management and Outcome

BACKGROUND

The myelodysplastic syndromes (MDS) are a group of stem cell disorders characterized by a reduction in one or more elements of the peripheral blood. Oral manifestations of the disease and oral complications of medical management may result in significant symptoms and have an impact on the systemic condition of the patient. The removal of the infectious focus, such active teeth infection or severe periodontal disease, remains controversial in these patients, due to the increased risk of bleeding and systemic infection.

METHODS

This paper reports a case of MDS with spontaneous gingival hemorrhage and generalized gingival hyperplasia associated with periodontal disease. This patient underwent several platelet transfusions due to these oral complications. The patient received periodontal therapy, resulting in an improvement of the oral clinical situation and a decrease of gingival hyperplasia.

RESULTS

The patient did not present any episode of gingival hemorrhage after the periodontal treatment.

CONCLUSION

The results of this study suggest that periodontal therapy should be performed in MDS patients presenting thrombocytopenia, gingival hyperplasia, and gingival bleeding, with the intent of preventing further hemorrhagic episodes and possible systemic infection.