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Medecine
DYNAMICS OF CHANGES IN THE FUNCTIONAL STATE OF HARD TISSUES
IN PATIENTS WITH HEMOPHILIA
Shamsiev M.K.
1
Norbutaev A.B.
2
Nazarova N.Sh.
3
1
Mukhiddin Kamariddinovich Shamsiev, Samarkand state medical Institute,
Uzbekistan
nodira.sharipovna2912@mail.ru
2
Alisher Berdikulovich Norbutaev, Samarkand state medical Institute, Uzbekistan
nodira.sharipovna2912@mail.ru
3
Nodira Sharipovna Nazarova, Samarkand state medical Institute, Uzbekistan
nodira.sharipovna2912@mail.ru
Hereditary coagulopathies, characterized by reduced blood coagulability, occupy a
special place among diseases of the blood system. The most common of these are
hemophilia and von Willebrand disease. Hemophilia - the disease of "royals" - an old,
but still actual disease.
Hereditary coagulopathies, characterized by reduced blood coagulability, occupy
a special place among diseases of the blood system. Based on WHO data and the
probable frequency of investigation of these diseases, the prevalence of hemophilia
ranges from 3 to 25 patients per 10 000 population.
A few studies of the state of the oral cavity in patients with hemophilia have
shown a high level of dental diseases, poor hygienic condition of the oral cavity. This is
due to the lack of proper oral care, and dispensary observation, fear of prolonged
bleeding after dental procedures. For this reason, dentists try to avoid the treatment of
dental diseases in this category of patients.
At the same time, modern advances in medical science in the field of hematology,
the development of effective substitution therapy can prevent almost all types of
bleeding.
However, until now, this contingent of patients is deprived of the opportunity to
receive timely and high-quality dental therapeutic and prophylactic care, which largely
determines the high prevalence of inflammatory diseases of the maxillofacial region.
All of the above is evidence of the presence of many predisposing factors for the
lesion of the dentition in patients with hemophilia, as well as the need for preventive,
therapeutic, including orthopedic dental measures for this category of patients.
Key words: Hemophilia, hard and soft tissues of the oral cavity, von Willebrand disease,
orthopedic treatment measures, dental status.
Hereditary coagulopathies, characterized by reduced blood clotting, occupy a
special place among diseases of the blood system. Based on who data and the likely
frequency of research on these diseases, the prevalence of hemophilia ranges from 3 to
25 patients per 10,000 population.
Material and methods: we examined 30 patients with hemophilia at the research
Institute of Hematology and blood transfusion of the Republic of Uzbekistan (Director
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Conference Proceedings. Scope Academic House, January 30, 2021, Sheffield, UK.
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Professor Karimov Kh.Ya.) aged 15 to 45 years. The control was performed by
practically healthy patients who applied to the dental clinic of the Department 1 of
dentistry of Sammi.
Results: in hemophilia, the mucosa of the alveolar ridge is pale, and there are
often no signs of gingivitis. Correctly positioned capillaries have almost the same
diameter, both in the arterial and venous parts. The capillaries are pink in color. The
capillary network is clearly visible, both in the area of the transitional fold and in the
area of the upper lip mucosa. The mucous membrane of the lower lip is darker in color
with signs of stagnation.
Often, patients are concerned not so much with heavy bleeding from the dental
wells, but with the formation of blood clots attached to these wells that SAG into the oral
cavity and prevent the patient from eating and talking. After colliding such clots with
the tongue or finger, bleeding resumes with the re-formation of sagging clots. Bleeding
gums were accompanied by hemorrhage in the oral mucosa of various locations: on the
lips, cheeks, tongue, and palate.
Thus, in cases of hemophilia, there are significant clinical and stomatoscopic
changes in the oral cavity, consisting in the presence of hypertrophy and edema of the
gums, atrophy of the alveolar ridge tissue, and bleeding of the mucous membrane in all
areas of the oral cavity. The revealed clinical features of the course of the disease cause
differentiated approaches to diagnosis, determination of severity and treatment tactics
in hemophilia.
Examination of the oral cavity in patients with hemophilia showed that all
patients have dental caries. The prevalence of caries in all age groups was 100 %.
As a control, a dental study was conducted in 20 somatically healthy individuals,
age groups corresponding to patients with hemophilia. Comparative analysis showed
that the prevalence of caries in the control group ranged from 86.7% to 95.3%. The
average rate in somatically healthy individuals is 91.6%.
Thus, with increasing age in the control group, the prevalence of dental caries
increases, and in patients with hemophilia, it remained the same and was equal to 100%.
The intensity of dental caries in patients depended on the severity of hemophilia.
The analysis showed that the average number of carious teeth in patients with
hemophilia was 6 times higher than in practically healthy individuals. The severity of
hemophilia is reflected in the value of this indicator. The average number of sealed teeth
in patients with hemophilia was significantly higher compared to the control group.
Regardless of the severity of hemophilia, the number of removed teeth was less
than in the control ones. The intensity of dental caries depends on the age of the subjects
and increases with increasing age both in the group of patients with hemophilia and in
practically healthy individuals.
Conclusion: in 100% of cases of hemophilia, dental caries was observed, the
intensity of which is associated with the severity of hemophilia. In patients with severe
hemophilia, caries occurs 2 times higher than in the group of patients with a mild degree.
With increasing age, the intensity of dental caries increased.
Patients with hemophilia have a low level of oral hygiene: the Fedorov-Volodkina
index was 2.5 times higher than in somatically healthy individuals, and the UIGR gave
an unsatisfactory assessment of oral hygiene in 90% of patients.
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The prevalence of periodontal diseases in hemophilia was high and amounted to
82%. Indicators of periodontal PMA indices exceeded the control values by 3 or more
times, which indicates severe periodontal tissue damage.
A comprehensive analysis of LDF grams indicates primary vascular damage of the
microhemocirculatory bed, and confirms its role in the occurrence of ulcerative-necrotic
changes and hemorrhage of the oral mucosa in patients with hemophilia.
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