Resident: Matthew Freitas
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2004. 26:4. 352-354.
-Idiopathic thrombocytopenic pupura (ITP) is a hemorrhagic disorder that causes an abnormal increase in the destruction of circulating platelets. It is the most common cause of thrombocytopenia in childhood. Chronic ITP is commonly due to autoantibodies directed against glycoproteins of platelets. The main danger in treating patients with ITP is hemorrhage. Prior to surgery, intravenous gamma globulin (IVIg) is recommended for children with platelet counts below 20,000. Elective surgery should be performed with a platelet count of 50,000.
-13 yr old boy with chronic ITP sustained traumatic labial luxation of teeth #24 and #25 with partial alveolar fracture. Bleeding was controlled with gauze and pressure. It was determined to reposition his teeth and alveolar plate under general anesthesia. Before surgery, intravenous immunoglobulin was given for 2 days, which rose the patient’s platelet count from 15,000 to 70,000. Displaced alveolus and teeth were then repositioned and splinted under general anesthesia, using a resin composite split to the labial of all lower incisors. Healing was uneventful and the splint was removed after 2 weeks. The patient was kept on a 3 month recall and both incisors were confirmed non-vital and endodontic treatment was performed.
-Platelets >50,000: little clinical bleeding is expected during minimally invasive dental treatment.
-Platelets <30,000: bleeding following dental procedures may be difficult to control. Regional anesthesia, such as a mandibular block is contraindicated.
**It is important when treating one of our patients with a bleeding disorder to work closely with the patient’s physician or hematologist.