The impact of immune thrombocytopenia on oral health: Let's talk Free

Introduction: The Immune Thrombocytopenia (ITP) World Impact Survey reported 40% of patients ranked gum bleeding as a severe symptom of ITP, yet the impact of ITP on oral health has not been addressed either in the literature or in published clinical guidelines. The goal of this study is to understand, from the patient's perspective, the impact of ITP on oral health.

Methods: We are currently conducting an explanatory sequential mixed methods study. Eligible patients are >4 years of age, have a diagnosis of primary ITP and have internet access. Recruitment of patients and caregivers is ongoing and includes recruitment from hematologists, posting on social media, and recruiting at the Platelet Disorder Support Association annual meeting.

The Oral Health Impact Profile-14 (OHIP-14) is administered online. It is a validated oral health-related quality of life instrument which assesses 7 domains (functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, handicap) with response options ranging from ‘Never’ (0 points) to ‘Very Often’ (4 points) with a maximum score of 56. Although there is not a published normative score, comparisons can be made across conditions, and higher scores indicate worse outcomes.

We supplemented the tool with ITP-specific questions on ITP history, intraoral symptoms (last 30 days), oral hygiene, and dental visits. The survey takes <10 minutes to complete and participants receive a $25 gift card.

The last question allows patients to agree to an individual interview. The 1-on-1 interviews will begin soon. The interview topics will focus on understanding oral health behaviors, oral health concerns and oral health discussions with medical providers.

Analysis: Descriptive statistics are used to describe the demographics of participants. Continuous variables are summarized (mean, standard deviation (sd), range).

Results: To date, there have been 68 survey responses. Patients are 78% White, 88% not Hispanic/Latino, 66% female, with a mean age of 45 years (range 6-85). The majority (73%) have private dental insurance, 76% have never used tobacco products, and 60% are college graduates. Patients are a median of 11.5 years from diagnosis, 59% are currently on ITP medication, and 62% currently have platelet counts >50X10⁹/L.

The overall OHIP-14 mean score was 7.2 (10.3 sd; range 0-43). Comparing to other disorders, the overall OHIP-14 mean score for patients with hemophilia was 4.5 (range 0-30) and 13.3 for survivors of oropharyngeal cancer. Descriptively, the mean OHIP-14 scores increased as the severity of thrombocytopenia increased (mean 4.6, >50X10⁹/L; mean 9.4, 30-50X10⁹/L; mean 13.9, <30X10⁹/L). The most affected domain (regardless of thrombocytopenia) was physical pain (ie, painful aching in the mouth).

The majority (88%) of patients saw a dentist last year, and 80% told their dentist they had ITP. While the majority (72%) of patients rate their ability to maintain their oral health as excellent/very good, only 43% rate the health of their teeth/gums as excellent/very good. Half (50%) of the patients had oral symptoms in the past 30 days with gum bleeding as the most prevalent symptom. When experiencing oral bleeding, the majority (55%) wait for it to resolve on its own without using remedies or medication. Most (74%) patients report brushing their teeth > 2X a day. Recalling the last 30 days, 28% report at least once a week the fear of bruising/bleeding in their mouth prevents them from brushing. Although only 4% of patients report being denied dental treatment, 31% experienced dental treatment delays because of needing prior consent from their hematologist.Conclusion: Patients with ITP had an OHIP-14 mean score of 7.2 compared to patients with hemophilia OHIP-14 mean score of 4.5, suggesting patients with ITP experience worse oral health-related quality of life than patients with hemophilia. Additionally, OHIP-14 scores increased (worsened) as thrombocytopenia increased. Finally, although patients with ITP believe they are maintaining good oral hygiene, only 74% adhere to the American Dental Association brushing recommendations. Patients also report experiencing dental treatment delays due to ITP. Our next steps include interviewing patients to understand the factors that influence oral health behavior and their oral health discussions with providers.