DENTAL AND ORAL MANAGEMENT IN BETA MAJOR THALASSEMIA IN CHILDREN

Characteristics; Growth and development of oral cavity in beta major thalassemia patients show several differences compared to normal children especially in terms of facial bone structures, dental arrangement and gingival color. The face and head of beta major thalassemia patients show a typical form known as facies Cooley or fasies thalassemia. The cranial bone is thickened resulting in frontal boneprotrusion with widened diploe space and thin external and internal plate. The excessivemalar bone grow due to the erythroid marrow expansion creates prominent cheeks and deepnasal base. According to Meredith and Higley, there is a relationship between the transversal grow of the head and face with the dental arch. The excessive maxillary bone grow creates dental malocclusion. The pneumatization of the maxillary sinus is commonly delayed in beta major thalassemia patients.

Radiographic characteristics of beta major thalassemia

The changes in beta major thalassemia patients bones that are caused by bone marrow hyperplasia can be observed in the radiographic images. Dipole in the cranial bones experience expansion that the inter plate space becomes widened while the external and internal part of the plate becomes thinner. The frontal bone creates a vertical tubercle that is parallel with the dipole plate external plate and, due to erythroid hyperplasia, the parietal bone has a porous part in the dipole plate external part that creates hair on end or sun ray appearance. The tubercle on the jaw bone can be seen in the panoramic image and gives Honeycomb appearance.

Oral cavity characteristics of beta major thalassemia patients

The oral cavity of the beta major thalassemia patients shows the following characteristics. The upper jaw seems to be bigger due to the bone marrow expansion. This facial feature is known as chipmunk facies. The lower jaw is wider than a normal lowerjaw. The tooth size is similar to normal child tooth except for the multiple diastema due to faster jaw growth. The periodontal ligament will seem widened as a result from Class IIDivision 1 malocclusion. The gingiva is pale especially when the patient’s Hb drops to below 8 g/dl. The color of the gingiva sometimes tends to be dark, which is caused by the highferritin level in the blood. The tongue size is bigger / macroglossi as a result from biggerarches.

Considerations during dental treatment

The treatment for beta major thalassemia is performed routinely especially whenpatients experience decreasing hemoglobin level. Therefore, the dental treatment should beperformed by paying attention to these following considerations. Consult all dental treatments planned with the hematologist. The dental treatmentshould be performed in a short time as possible and should be done after the patient receivesblood transfusion. Do not do dental treatment when the hemoglobin level is less than 10 g/dl. Provide antibiotics prophylaxis especially for children who have undergone splenectomy. Ifan orthodontic treatment is needed, the dental movement should be watched closely becausethere may be faster movement compared to the normal situation. The retention phase is alsomore difficult in these patients.

CONCLUSION

The anemic condition in beta major thalassemia patients makes patients lazy to clean their teeth that the oral hygiene becomes poor and a high caries index is found. The dentist, especially the pediatric dentist, should be careful in giving dental treatment. The cooperation with the hematology expert should be established in each treatment action.освещение офисов магазиновukladka-parketa.comкупить брюки для мальчика