BLEEDING GUMS
BLEEDING GUMS: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the following questions:
- Are there abnormalities on examination of the teeth or gums? The gums may be swollen, as in phenytoin use and early scurvy, and bleed on slight pressure, as in pyorrhea or other conditions. There may be ulceration of the tongue, gums, and buccal mucosa. There may be an isolated dental caries that is causing bleeding. Excessive tartar may be noted on the teeth.
- Is there an enlarged spleen or a systemic rash? The presence of an enlarged spleen should bring to mind Hodgkin's disease, leukemia, lupus erythematosus, thrombocytopenia purpura, and aplastic anemia. A systemic rash that is due to petechiae is common in any disorder that might cause thrombocytopenia.
- Is there a positive Rumpel-Leede test? This would test for capillary fragility, and it may be positive in scurvy, thrombocytopenia purpura, leukemia, and other disorders that depress the platelet count. It will also be positive in disorders of platelet function such as von Willebrand's disease.
DIAGNOSTIC WORKUP
A CBC, sedimentation rate, chemistry panel, ANA titer, and coagulation profile are basic studies that need to be done. If these are negative, referral to a dentist or periodontist would be appropriate. X-rays of the teeth need to be done to look for dental caries, abscesses, and pyorrhea. X-rays of the teeth will also help identify scurvy. A plasma or platelet ascorbic acid level needs to be done if scurvy is suspected. If syphilis is suspected, a VDRL test needs to be done.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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