Thrombocytopenia

The terms thrombocytopenia and thrombopenia refer to a relative decrease of platelets in blood.

A normal human platelet count ranges from 150,000 to 450,000 platelets per microlitre of blood. These limits are determined by the 2.5th lower and upper percentile, so values outside this range do not necessarily indicate disease. One common definition of thrombocytopenia is a platelet count below 50,000 per microlitre (From Wikipedia).

Mr. Qiu has normal teeth, gums and bone.  For example, the bone of his lower left first molar (Fig.1 M1) is symmetrical and equal in height, front and back (*).  Since last Halloween, he has had mild discomfort.  The bone in the back of this molar is lower (Fig.2 blue *).  We suspect root crack.  Three months later, an abscess develops (Fig.3*) with oozing from the gums (<).  The molar tooth needs to be extracted, but Mr.Qiu's platelet count is 40,000 per microlitre.  After analysis of his general condition, we decide to take it out.  It turns out that the extraction is uneventful.  No excessive bleeding is encountered.  Nine days later, the socket is healing: edges of the wound approaching each other (Fig.4 <).  Two and a half months later, the wound has healed (Fig.5 *)!  But the bone and gums have shrunk a lot in the socket (follow arrowheads in Fig.5, also compare to Fig.4).  Shrinking of the extraction socket happens quick.  An implant is placed (Fig.6 I) to prevent this on-going process (shrinking).  Equally amazing is that Mr. Qiu is doing well during the implant surgery.  There is no much bleeding considering his thrombocytopenia.  We wish him smooth recovery.  In fact, he is doing great after surgery with tinny tiny swelling.

Bone grows around the implant less than 5 months after placement (Fig.7 *, as compared to Fig.6).  In fact the implant is strong enough now to accept abutment and crown.  But the patient wants to wait until next year when his dental insurance will cover the procedures.  We will see you then.

Xin Wei, DDS, PhD, MS 1st edition 04/28/2013, last revision 09/26/2013