Significance of Periodontal Health in Primary Immune Thrombocytopenia- A Case Report and Review of Literature
A 19-year-old Indian female reported to the Department of Periodontics at Govt Dental College, Rohtak with a chief complaint of spontaneous gingival bleeding. Discoloration and bruising of the lips were strikingly noticed even before a formal clinical examination had begun. Medical history revealed that she was diagnosed with ITP three years ago after an unexplained episode of high-grade fever. She was treated with oral corticosteroids for a few months which caused only a transient and unstable improvement of the platelet count. A year later, she underwent splenectomy, which maintained her platelet count at approximately 45,000/mm3 without treatment.\nExtraoral examination revealed excessively dry lips, which were mildly bruised. There were no lesions anywhere else on the body at the time. Intraoral examination revealed poor oral hygiene, spontaneous gingival bleeding and an edematous, shiny and somewhat fiery red in color gingiva (). Submucosal ecchymosis at the tip of the tongue as well discoloration on the palate was noticed (, ). Halitosis was also present. Intra-oral periapical radiograph of the lower anterior region depicted mild horizontal bone loss.\nOn questioning about oral hygiene habits, the patient revealed that she had stopped brushing from 4–5 months before, as she was afraid that it would further increase oral bleeding. Apart from oral signs and symptoms, the patient also disclosed experiencing unusually heavy menses in the past few months and also frequent episodes of skin discolorations even with very mild trauma.\nA complete hemogram was carried out which revealed a platelet count of 18,000/mm3, hemoglobin concentration of 11.5g/dL and a total leucocyte count of 10000/mm3.\nTaking into consideration the low platelet count and history as obtained, the patient was referred to the department of hematology regarding suitability of dental treatment at the time. The hematologist prescribed corticosteroids for the patient and her platelet count increased to 72,000/mm3.\nPeriodontal therapy was initiated with debridement, supra and sub-gingival scaling and root planing. Post scaling, the patient was put on tranexamic acid mouthwash twice daily for 3 days. She was motivated and taught to practice good oral hygiene habits which included regular brushing of the teeth with a soft-bristle toothbrush and 0.2% chlorhexidine mouthrinses.\nDietary recommendations were made. Two weeks later, the inflammation had subsided and spontaneous bleeding was no longer evident (). She reported back for follow up after 6 months, at which she was in a state of good periodontal health ().