Determining the effect of using supragingival geysers containing chlorhexidine and sterile gas on the oral health index in people with blood dyscrasias.

Dissertation for receiving a doctorate degree in dentistry

Abstract:

Introduction: Oral and dental problems are one of the potentially life-threatening problems in patients undergoing chemotherapy with blood dyscrasias. This study is designed to investigate a new strategy to improve health in these people.

Results: The average debris index (DI-S) decreased by 59.78% in the study period in the case group compared to the control group, but the average mass index (CI-S) in none of the groups during this period was not different from the mass index on the first day of examination. According to these two indicators, the total oral health index (OHI-S = Oral Health Index-Simplified) in the case group, on the first day of examination, 37.5% was good, 56.25% was average and 6.25% has been poor and improved to 100% good after 3 weeks. In the control group, the oral hygiene index on the first day of the examination was 56.25% good, 37025% average, and 6.25% poor, and after 3 weeks, it changed to 18.75% good, 75% average, and 6.25% poor. The incidence of mucositis was 0% in the case group and 31.25% in the control group.

Conclusions and suggestions: According to statistical and clinical findings, supragingival geyser can be effective in significantly reducing the debris index and improving the oral hygiene index and maintaining it during the treatment of the disease, and due to its lower risk compared to toothbrushes and on the other hand, the greater ease of its use by patients or nurses, it can be implemented as a standard protocol in hospitals for these people.

Keywords: supragingival geyser Gingival, Leukemia, Blood dyscrasia, Oral Health Index (OHI

Introduction

1-2 Leukemia

Definition: Leukemia is a type of blood cancer that is classified as a part of abnormalities called "hematological neoplasms" (1) and a type of malignancy. In hematopoietic stem cell derivatives, it is caused by the proliferation of a clone of abnormal hematopoietic cells in which differentiation, regulation and programmed cell death (apoptosis) are impaired. These malignant cells first proliferate in the bone marrow and then enter the peripheral blood of the affected person. Problems arise when leukemic cells take the place of normal defense cells and precursors of erythrocytes.

The cause of leukemia is unknown in most cases, and several factors that increase the chance of contracting the disease have not been well proven, including genetic factors that play a role in some cases of leukemia. Some of these factors include:

Genetic disorders such as Down syndrome, Klinefelter and Fanconi anemia

Radiation in excess of GY 1

Acute leukemia has occurred following the use of the drug phenylbutazone (related to arthritis) and the antibiotic chloramphenicol (2)

But the overall contribution of environmental factors in leukemia is less than 5%. (1)

According to 2007 statistics, leukemia in the United States accounts for approximately 3% of cancers and 4% of cancer deaths are related to this disease. (2) Men are slightly more likely to be affected than women. There are still no accurate statistics of cases of this disease in Iran.

Leukemia is divided into two types, acute and chronic, based on the clinical course, and based on histogenic origin and the first type of hematopoietic cell that is affected (myeloid or lymphoid) into two types, myeloid and lymphocytic (or lymphoblastic) (2), as a result, we have 4 types of leukemia:

1-2-1 acute leukemia: rapid increase in the number of immature blood cells. The accumulation of these cells makes the bone marrow unable to produce healthy blood cells.Immediate treatment of this type of leukemia is necessary due to the rapid spread and accumulation of malignant cells and their metastasis to other organs of the body. This type of leukemia is the most common type of leukemia in children.

Chronic leukemia: high production of abnormal but relatively mature white blood cells. Its progression lasts for months or years and often happens in adults.

Lymphocytic leukemia: In this division, malignant changes occur in the part of the bone marrow that is supposed to make lymphocyte cells, and often these changes involve a specific subgroup of lymphocytes, namely B-cells.

Myelocytic leukemia: In this division, Malignant changes occur in a part of the bone marrow that is supposed to make red blood cells (RBC) and platelets.

Introduction: Oral and dental problems are one of the potentially fatal problems in patients suffering from blood dyscrasia that are involved with chemo and radiation therapy. The goal of this study is to assess a new approach to increase the hygiene level in these patients.

Methods and Materials: in this random clinical trial we have selected 32 Imam Reza hospital patients, suffering from blood dyscrasia, to study the effects of supra-gingival irrigators in Oral Hygine Index Simplified (OHI-S) compared with the use of humid sterile gauze (common protocol in hospital) in 3 weeks.

Result: the Debris Index Simplified (DI-S) has 59.78% reduction in case group compared to control group but Calculus Index Simplified (CI-S) doesn't have any difference in these 3 weeks. According to these 2 indices: in case group, OHI-S was 37.5% good, 56.25% fair and 6.25% poor in the first day examined but 100% good in the last follow up. and in control group: OHI-S was 56.25% good, 37.5% fair and 6.25% poor in the first day examined but only 18.75% good in the last follow up. 75% was fair and 6.25% was poor.

Conclusion: According to statistical and clinical results, supragingival irrigation can decrease DI-S and increase OHI-S significantly and preserve the oral hygiene in these patients in the period of hospitalization and because of it's safety that is more than tooth brushing and it's easy application for patients and nurses, it can be used as a standard protocol in hospitals.