electronic-Perak Medical Journal. August 2019; Volume 1, Special Issue 2
Journal homepage: http://gids.mohe.gov.my/index.php/pmj
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CONFERENCE PROCEEDINGS
This abstract was submitted to Perak Research Conference 2019 20 August 2019
MANAGEMENT OF COMPLICATIONS OF DENTAL EXTRACTION IN A PATIENT WITH MYELODYSPLATIC SYNDROME: A NOVEL APPROACH
Hui Wen Tay, Wan Choon Ong, Singh Namkabir, Rithuan Awang, Ferdinand J Kovilpillai Oral and Maxillofacial Department, Taiping Hospital, Ministry of Health MALAYSIA
ABSTRACT
Keywords Not available Research ID: 47806
Correspondence to:
Tay Hui Wen [email protected] Back to Content Page INTRODUCTION & OBJECTIVES
Myelodysplastic syndrome is an acquired group of haematological disorders characterized by ineffective haematopoiesis, dysplastic changes of haematopoietic cells and chronic cytopenia. Patients with myelodysplastic syndromes may have symptoms of anaemia, increased risk of infections due to leukocytopenia and a tendency for bleeding due to thrombocytopenia. Spontaneous gingival bleeding, gingival hyperplasia, periodontal diseases, oral ulcers and oral infections are the common oral manifestations and complications that may occur in patients with myelodysplastic syndrome. Dental extraction to remove an active infection or severe periodontal disease and the management of its complications also pose certain difficulties and challenges in these patients.
CASE PRESENTATION
A 41-year-old Malay gentleman, with underlying myelodysplastic syndrome presented to us with a complaint of spontaneous gum bleeding for the last 4 days. On examination, oral hygiene was very poor with abundant plaque and calcalus. The source of bleeding was from the highly inflamed gingiva at the upper right quadrant with four extremely mobile teeth. Orthopantomogram (OPG) taken showed generalized bone loss involving more than half of the root length, indicating severe chronic periodontitis. Blood investigations revealed a platelet of 6x10^9/L, total white blood count of 1.5x10^9/L and haemoglobin of 14.4g/dL. Following consultation with the haematologist, platelet transfusion was performed prior to extraction of four teeth in a hospital setting. Antibiotic prophylaxis of 2g Amoxicillin was also given pre-operatively. Despite local haemostatic measures including placement of surgicel, suturing of the extraction sockets, gauze compression with ferric sulphate and a prescription of 5% tranexamic acid mouthwash thrice daily for a week, oozing of blood from the extraction sockets still persisted after more than 24 hours. On day 1 post extraction, the patient started to develop hematoma at the right upper buccal sulcus and mild swelling at the right cheek. Post-operative intravenous tranexamic acid and platelet transfusion were administered and the bleeding was finally arrested and he was discharged from the ward. However, he presented back to us with prolonged bleeding from the extraction sockets after 3 days. All local haemostatic measures were reinforced and a more novel approach – construction of a soft splint and placement over the extraction sites will be presented in this case.
CONCLUSION
For patients with myelodysplastic syndrome, the maintenance of proper oral hygiene is imperative. This to prevent the progression of dental diseases at the earliest stage possible to avoid the need for more invasive procedures in the future.
This case report also aims to create and increase the awareness of practitioners of the possible difficulties and challenges faced in the dental management of patients with myelodysplastic syndrome and the necessary precautions to be taken.
Practitioners may also be required to think out of the box and apply a more innovative approach, as in this case.
