Spontaneous severe gingival bleeding

A 10-year-old male patient presented for spontaneous severe gingival bleeding during the last 2 days. The child’s physical examination revealed a short stature. HB: 6.3 g/dl Platlet: 6000 /ul WBC: 1170/mm3 The intraoral examination revealed petechial hemorrhages with oozing blood from the gingiva, poor oral hygiene and discolored teeth. However, the gingival bleeding was scarce. Can you diagnose this case?

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@Dr. Sandhya Negi Seeing the current scenario of blood parameters.... Dx Anemia with Thrombocytopenia Rx Firstly, Physician to be consulted and after Taking medications fr 15 days again another blood investigation to be done then continue or change or increase the dose of the medications plus supplements accordingly... Secondly, Once conditions are under control then can think about oral prophylaxis that to under an Antibiotic coverage and two sittings( Don't rush to finish of the case) as local factors are well appreciated clinically. Thirdly, Instruct him the proper brushing technique plus teach to his parents as well so that they can take care off.
Decline in blood parameters suggests of anemia with thrombocytopenia could possibly be owing to aplastic anemia or myelodysplastic syndrome. Adv complete haematological profiling. Oral findings suggests of chronic generalised gingivitis with localised periodobtitis adv sequential oral prophylaxis (meticulous supragingival scaling, pit and fissure sealant, OHI) under prophylactic antibiotics, CHX mouth wash, stolin gum paint. Treatment to be commenced only after diagnosis of underlying systemic condition abided by physician consent.
It's Pancytopenia with linear gingival erythema, this condition can be genetic or due to some sort of tissue transplant for which the patient is on immunosuppressive drugs. To remind all chaps here LGE may or may not be associated with immunosuppression / immunocompromised state. The mammelons are intact means patient is mouth breather and remarkable periodontal status which could be again related to trisomy 21 .
Goodevening Doctor, P.d generalised gingivitis + severe ANEMIA + severe THTOMBOCYTOPENIA + LEUKOPENIA **EMERGENCY CONDITION Suggestive of bone marrow dysfunction. Rx- Oral prophylaxis asap in 1 sitting to avoid unwanted opp. Infections, since WBC are less - Emergency admission of patient to hospital for further investigations and treatment. *Emergency !
I would suggest ...that delay the dental treatment and be fast in referring the patient to the physician as patient is moderately anaemic.... He can land up into SYNCOPE if you attempt any treatment now... And also all the routine blood investigations need to be done... Till then mouthwashes can be prescribed...
Agreed with @Dr. Abhishek Dubey Pancytopenia as it occurs when all three types of blood cells count is low. Other than this it includes petechial hemorrhages, gingival swelling and spontaneous bleeding, ulceration, pallor and severe periodontal disease as mentioned in the case history.
SUGGESTIVE of SEVERE. ANEMIA WITH SEVERE THROMBOCYTOPENIA POSSIBLY APLASTIC. ANEMIA DD DRUG. INDUCED OR POST. VIRAL. DISEASE.. ADVISABLE.. 1. CULTURE. AND. SENSITIVITY. TESTS 2. IMMEDIATE. I. C. U. ..MANAGEMENT 3. BLOOD. TRANSFUSION.. 4. BONE. MARROW. STUDY
Blood parameters are severely altered.... Mostly this bleeding are in association of some blood disorders which is also superimposed with the local deposits... JUST REFER TO PHYSICIAN OR HEAMATOLOGIST...
Adv Scaling and cleaning of gum with mixture of metrogyl nd NS Solutions Tab-amoxy 125 mg BD Tab-flagyl 400 mg in 3divided dose Multivitamins nd minerals for 5days Warm saline rinses 2-3 times
Adv CBC reports Dd-Anaemia Dentaldx-chronic generalised gingivitis with localised periodontitis irt 33 to 43( lower anteriors) Rx-Oral prophylaxis Maintenance of oral hygiene Metrogyl gel Also advise must brushing twice a day Recall after a week n follow up
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