Management of patients with aphthous-like ulcers related to aplastic anaemia in the COVID-19 pandemic era through teledentistry: A case report

Abstract

Background: Aplastic anaemia is a disease that occurs when the body fails to produce enough blood cells. Oral lesions, such as canker sores, are often used as an early marker of this disease condition. In the COVID-19 pandemic era, a teledentistry method is expected to assist in the management of patients with various diseases including aplastic anaemia. Purpose: This case report discusses the management of patients with aphthous-like ulcers related to aplastic anaemia in a 34-year-old woman, based on history, clinical examination, and blood tests through teledentistry. Case: The patient complained of a bleeding wound on the inner left cheek and corner of the left lip that appeared one month ago. There was an ulcer lesion that was bleeding easily in the buccal mucosa sinistra and the angular sinistra, as well as macules lesion on her hand and foot. The complete blood count test exhibits a low platelet level. Case management: The diagnosis was an aphthous-like ulcer related to aplastic anaemia. Patient was treated with topical antiseptic and anti-inflammatory mouthwashes for the oral lesions, as well as collaboration with the medical team. The lesions improved after the patient received a blood transfusion and drug therapy from the internist while she was hospitalized, but the lesions reappeared in other locations in the oral cavity when the platelet level dropped. Conclusion: Management of oral manifestations in patients with aphthous-like ulcers related to aplastic anaemia in the COVID-19 pandemic era can be done through teledentistry. However, this requires sensitivity from the dentist, patient compliance in following instructions, and the involvement of a multidisciplinary approach, such as collaboration with internists to achieve recovery. Delay in detecting and treating aplastic anaemia will lead to death, as in this case.

The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not?

“…Antibiotics and analgesics were reported to be the most used drugs for COVID-19 patients. Antibiotics include amoxicillin-clavulanic, 101 azithromycin, 73 , 77 , 81 , 83 , 101 , 116 , 126 moxifloxacin, 91 levofloxacin, 77 penicillin, 96 ceftriaxone, 95 cefixime, 110 piperacillin-tazobactam, 100 doxycycline 100 and cefadroxil 105 ( Table 11 ).…”

“…The anti-inflammatory and antipyretic drugs include dipyrone, 83 , 113 acetaminophen, 90 , 96 , 101 , 119 , 132 ibuprofen, 81 acetylsalicylic acid, 77 paracetamol 73 , 95 , 101 Steroids also prescribe dexamethasone, 77 , 111 , 113 prednisone 77 and methylprednisolone. 100 Other types of drugs include proton pump inhibitors, 91 anti-malaria, 73 , 95 , 116 anti-virus, 73 , 100 , 116 antihistamine, 90 mucolytic, 77 , 101 , 111 anticholinergic, 77 anti-coagulant, 95 , 96 , 100 , 111 antiparasitic, 126 anti-gout, 111 anti-gerd, 111 anti-depressant 110 , 111 and multivitamin 73 , 81 , 91 , 95 , 101 , 105 , 111 ( Table 11 ).…”

“…Oral lesion-related medication is sometimes also found with a skin lesion. The most common lesion was ulcer, 73 , 81 , 96 , 105 , 110 , 116 , 119 crust, 96 , 105 , 116 , 132 macula, 136 vesicle, 132 and vesiculobullous, 96 with skin lesions in the form of petechiae, 81 macula, 96 , 110 , 119 papula, 96 , 119 , 132 exanthem 73 , 110 and targetoid lesions. 116 The oral lesion mostly affected on lip, 96 , 105 , 116 , 119 , 132 while others were on other mucosae 73 ( Table 12 ).…”

“… 116 The oral lesion mostly affected on lip, 96 , 105 , 116 , 119 , 132 while others were on other mucosae 73 ( Table 12 ).…”

Detection of caries and determination of treatment needs using DentMA teledentistry: A deep learning approach

“…Therefore, to facilitate patient access such that they could continue receiving health services, dentists provided consulting services and disease therapy as first aid through teledentistry. 10 During the COVID-19 pandemic period, patients' medical histories, objective examinations, treatment planning, and oral complaints were all addressed through teledentistry. The management of patients through teledentistry considers the sensitivity of the dentist in detecting disease, patient compliance in carrying out the dentist's instructions, and the selection of medications that are both easy to obtain and safe.…”