The role of oral hygiene in a patient with idiopathic thrombocytopenic purpura.

OBJECTIVE: Idiopathic thrombocytopenic purpura (ITP) is an acquired disease of children and adults defined as isolated thrombocytopenia with no clinically apparent associated conditions or other causes of thrombocytopenia. Oral manifestations are gingival bleeding, petechiae, mucocutaneous bleeding and haemorrhage into tissues. CASE DESCRIPTION AND RESULTS: An 11-year-old Turkish female was referred to the periodontology clinic by the paediatric haematologist for the treatment of spontaneous gingival bleeding, gingival oedematous enlargement and hyperaemia. She was diagnosed as chronic ITP 6 months ago and she was told not to brush her teeth. She was also complaining with dull pain and oral malodor. She was motivated for oral hygiene and after consulting with paediatric haematologist, under the proper circumstances, dental plaque and calculus were removed. Healing was uneventful. CONCLUSION: Oral hygiene motivation and dental plaque control is crucial in order to prevent gingival bleeding, inflammation and severe periodontal diseases in patients with haematologic disorders. Understanding of the oral findings is essential in the management of patients and close cooperation between patients' dentist and haematologist is needed. Dental consultation is essential for diagnosis and improvement of medical conditions. It is possible to obtain adequate oral hygiene with limited performance and haematologic disorders are not handicaps for dental/periodontal procedures under the proper circumstances.

Periodontal health and adverse pregnancy outcome in 3,576 Turkish women.

BACKGROUND: Preterm low birth weight (PLBW) is a problem encountered worldwide. The many causes of low birth weight (LBW) and premature or preterm birth (PTB) vary among developing/industrialized countries. Few studies have been published, in part because of the paucity of subjects and the ethnic heterogeneity of the populations. Our goals were to correlate maternal periodontal disease with birth outcomes in a Turkish population and evaluate maternal periodontal health. METHODS: This study consisted of 3,576 Turkish women who gave birth within 24 hours of the onset of labor. The adjusted odds ratio was generated from various logistic regression models. RESULTS: Codes from the Community Periodontal Index of Treatment Needs (CPITN) were evaluated according to treatment need (TN). The TN-I rate was 24.2% (N=866), the TN-II rate was 73.5% (N=2,628), and the TN-III rate was 2.3% (N=82). There were 566 (15.8%) adverse birth outcomes; the PTB with LBW rate was 4.2%; the PTB with normal birth weight (NBW) rate was 8.3%; the in term birth with LBW rate was 3.3%, and the in term birth with NBW rate was 84.2%. The overall PTB rate was 12.5% (N=447), and the LBW rate was 7.5% (N=269). The mean birth weight and weeks of gestation decreased as the CPITN level increased (P<0.001 for both). The LBW rate was 4.6% in the TN-I group, 8.3% in the TN-II group, and 14.6% in the TN-III group. TPTB rates were 10.5%, 12.7%, and 26.8%, respectively, whereas adverse birth outcome rates were 12.0%, 16.6%, and 30.5%, respectively (P<0.01 for all). TN-II and TN-III were independent risk factors for LBW, PTB, and abnormal births in regression analyses. CONCLUSION: Maternal periodontal disease may be a risk factor for an adverse pregnancy outcome.

Three siblings with juvenile hyaline fibromatosis.

Juvenile hyaline fibromatosis (JHF) is an extremely rare hereditary genetic disease of autosomal recessive transmission that is characterized by large cutaneous tumors commonly involving the scalp, papulonodular skin lesions, flexural joint contractures, gingival hyperplasia, and osteolytic bone lesions. JHF is usually diagnosed in young infants and in children younger than 5 years, and the lesions characteristic of this disorder consist of fibrous tissue and homogenous amorphous eosinophilic hyaline material. We report the case of a 9-year-old girl with severe gingival hyperplasia, nasal enlargement, mild osteoporosis, and multiple papulonodular skin lesions. Her two brothers (7 and 13 years of age, respectively) were also diagnosed as having JHF. In the patient described in this report, the maintenance of oral hygiene after gingivectomy enabled the continued resolution of gingival hyperplasia, although skin lesions recurred and nasal overgrowth persisted.