Comprehensive Dental Management of Children With Henoch-Schonlein Purpura-Vera Yulina

Comp
Mana rehensiv
geme e Den
with H nt of tal
enoch Childre
-Scho n
Purpu nlein
ra
Prof. D Vera Y
R . drg. W u lina
illyanti
Soewo
ndo, S
p. KGA
(K)
Henöch-Schonlein Purpura (HSP)
Sample 2
Poor OH  some
systemic /
90% < 10 yo ( with a autoimmune
mean of age is 6 yo) diseases
Vasculitis
HSP
Most common in
chidren SHCN 
10-20/100.000 / year high risk
of oral
Upper respiratory tract infection
infection,medication,
vactination, malignancy, &
odontogenic infection
UK
20.4/100.000
ASIA
24 / 100.000
4
John Lukas Schönlein Edward Henoch (1837)
Relationship between 4 children with
arthralgia-purpura skin abdominal pain  skin
lesions  peliosis vasculitis, arthritis &
rheumatica renal involment
William Heberdeen
(1801)
5 yo boy (abdominal pain,
gag, arthralgia, rash
purpura & hematuria)
DIES FORUM UNPAD 2019- Comprehensive Dental Management of Children with Henoch Schonlein Purpura: A Case Report- Vera Yulina
Clinical features
Skin & joints GI Renal involment  nefritis HSP
Central nerve
system involment
24 hours makula 
red purpura lesions
Symmetrical  purple 
Macular rash (parts yellowish-brown 
of the skin that are disappear  new
Arthralgia & lesion
arthritis 1-2 d  affected by
skin lesions (knee, pressure)
Upper respiratory
tract infection (mild ankle, , wrist,
fever + headache) 1- elbows, joints,
3w fingers)
Systemic Diseases Vs Odontogenic Infection
Dermatological
Diseases
Odontogenic
Infection
Autoimmune
Diseases
Igawa, 2011
an oral focal infection could be a precipitating factor for adult
HSP, as improvements in the skin lesions were observed after
patients being treated for the oral infection
Enzenauer, 1990 Ghrahani, 2006-2011 RSHS Bandung
13.3% HSP is caused by odontogenic infection

Recurrent HSP  gingival petechiae & mandibular pain
Tahmassebi, 2007 Ghrahani, 2013 RSHS Bandung
Infeksi odontogenic  as the biggest precipitating factor in

A case of HSP following endodontic treatment Glomerulonephritis HSP
Inoue, 2008
dental caries (70%) along with apical periodontitis (53%) was
found in HSP cases and conclude that early and extensive
why does HSP often
treatment for these lesions may prevent the complication of HSP
occur in children?
Inoue CN, Periodontal and ENT therapy in the treatment of pediatric henoch-schönlein purpura and IgA nephropathy. Adv Otorhinolaryngol. 2011;72:53–6
Bacterial pathogens  blood stream sIgA oral mucosa fails to eliminate

 damaging the inside smooth lining bacterial antigens owing to the presence
of the the blood vessel walls of a tremendous amount of bacteria
Odontogenic
infection as
the potential
to trigger HSP
Many degraded bacterial 1000 billion

products and the decomposition bacteria cytokines Persistence of active
products of pulp tissue stagnate colonize immune reactions
in the lesion (aerob/anaerob)
Dental Management
HSP/
Odontogenic
infection Nephritis
HSP
Active infectious
Comprehensive
foci must be
dental
exhaustively
management
eradicated
Name : Arfan Ziqri Sastrawijaya
Medical record : 2018-002634
Date of birth/age : March 29, 2013/ 5 y.o
Sex : Male
Class : TK B
Adress : Komp Bumi Panyileukan citra AC 1/8
Parent’s name : Muhammad Willi
Hp : 081222460552
A 5-year-old boy was referred to RSGM Unpad with chief complaints severe dental caries. 1 year ago
the patient was hospitalized with a diagnosis of Henöch-Schonlein Purpura (HSP). The patient was
treated by a specialist pediatric allergy-immunology division. Patients were referred for dental and oral
care.
Skin lesions begin with small patches like insect bites
 enlarge (purple, irregular)
Swelling of the joins
Renal involment
Microscopic hematuria, macroscopic hematuria &

proteinuria
Nefritis HSP
Severe complications of HSP death
urinalis
protenuria >0.3 g/24 hours or albumin ratio/keratin

>30 mmol/mg in the urine (in the morning)
High Netrofil segmen level  shift to the left
Infection : bacteria & malaria

Non infection: allergy
High platelets level

immunological disease, heart disease, cirrhosis
No Tooth The Diagnosis Treatment planning
1 Maxillary and Mandibular Generalized chronic gingivitis Scalling
2 55 Pulp necrosis Non vital pulpectomy  stainless steel
crown
3 52,51, & 61 Reversible pulpitis Composite strip crown restoration
4 64 Reversible pulpitis Glass ionomer cement (GIC) tooth

restoration
5 65 Reversible pulpitis Indirect Pulpcapping with CaOH & GIC
6 75 Reversible pulpitis Stainless steel crown tooth restoration
7 74 Irreversible pulpitis Vital pulpotomy  stainless steel crown
8 84 Pulp necrosis Non vital pulpectomy Stainless steel

crown
9 85 Reversible pulpitis Stainless steel crown tooth restoration
10 Maxillary and mandibular Topical Fluoride Application
Dental Management
HSP can appear as a consequence of the dental procedure
Children with HSPG are highly susceptible to oral diseases, particularly to(70% dental caries & 5% apical
periodontitis)
Children with HSP, especially Glomerulonephritis HSP  comprehensive dental treatment to avoid
dissemination of the infection to other internal organs  systemic serious sequelae, and thus worsening
the prognosis of the disease
Comprehensive dental treatment (Home care, varnish fluoride, dietary counseling, pit and fissure sealants,
periodically visiting dentist)
Conclusion
A pediatric dentist must be knowledgeable and aware of HSP and the
importance of maintaining the overall oral health status of their
patients to prevent additional systemic complications
This responsibility is shared with other health practitioners, such as

pediatricians and nephrologists. The main objective is to improve the
Oral Health-related Quality of Life of the HSP patients.

Comprehensive Dental Management of Children With Henoch-Schonlein Purpura-Vera Yulina

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Comp

Skin & joints GI Renal involment  nefritis HSP

Enzenauer, 1990 Ghrahani, 2006-2011 RSHS Bandung

13.3% HSP is caused by odontogenic infection

Tahmassebi, 2007 Ghrahani, 2013 RSHS Bandung

Infeksi odontogenic  as the biggest precipitating factor in

Bacterial pathogens  blood stream sIgA oral mucosa fails to eliminate

Many degraded bacterial 1000 billion

Swelling of the joins

Microscopic hematuria, macroscopic hematuria &

Severe complications of HSP death

protenuria >0.3 g/24 hours or albumin ratio/keratin

Infection : bacteria & malaria

High platelets level

4 64 Reversible pulpitis Glass ionomer cement (GIC) tooth

8 84 Pulp necrosis Non vital pulpectomy Stainless steel

This responsibility is shared with other health practitioners, such as

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