Case report: oral manifestations of young patient suffering from both thalassemia major and hepatitis b

Introduction Thalassemia is a hereditary hemolytic anemia characterized by the inability of erythroblasts to produce the beta-chain of the hemoglobin structure. Patients with thalassemia acquire hepatitis most often from viruses contracted from blood transfusions especially in developing countries like Pakistan. This case reports the distinct oral manifestations in a young patient with thalassemia major and hepatitis B. Case Report An 8-year-old male patient visited Jinnah Sindh Dental Outpatient Department with the complaint of bleeding gums. According to the history, the patient was suffering from beta-thalassemia congenitally. Both parents were normal (carrier). He had 5 siblings of which 4 were phenotypically healthy (carriers). A 12-year-old sister had died because of beta-thalassemia. The patient had undergone regular blood transfusion from the age of 5 years. The patient was diagnosed with hepatitis 2 months ago, possibly due to contaminated blood transfusion. Clinical Findings The clinical examination showed that the patient was poorly built and undernourished with short stature. The prominent dental arch parameters evident were the characteristic appearance known as “chipmunk face” (caused by hyperplasia of bone marrow in the maxilla that exceeds the mandible). Frontal and parietal bossing with depressed nasal bridge were present. Oral Findings Intraoral examination demonstrated class II malocclusion along with maxillary protrusion. Other findings included overcrowding of mandibular anteriors, proclined upper anterior teeth, generalized yellowish discolored teeth, mild generalized diastema, and localized periodontitis affecting the lower anteriors. Multiple decayed teeth with heavy deposition of calculus and plaque on teeth with dark stains were also seen.