What Are Senile Oral Purpuras?
Senile purpura (SP) is the medical term used to describe ecchymosis (a type of bruise or discoloration of the skin caused by bleeding underneath) or purpuric oral lesions (skin or mucous membrane spots that are purple due to bleeding underneath) in senior or elderly population groups who are otherwise healthy. Medical literature suggests that blood vessel pooling and bruising under the skin can cause these purpuras. This can happen in elderly individuals even under the oral mucous membranes, oral soft tissues, or gingival tissues (gum tissues surrounding the teeth), in geriatric or elderly individuals who may be otherwise healthy and not even on any systemic medications. Individuals taking systemic medications or anticoagulant therapies or having any other previous medical history, suffering from oral purpuras would have an underlying oral or systemic infection that would prompt their occurrence.
Senile purpuras are primarily observed as a result of the natural physiologic process of aging either in the exposed surfaces of the body extremities such as arms, legs, face, lips, peri-oral tissues, tongue, or oral mucosa or mucous membranes (moist lining inside the mouth), other purpuras occurring following any kind of minor trauma, injury, or surgically induced trauma as in the case of post-operative purpuras require hemostatic management (methods used to control or stop bleeding) or bleeding control by a dentist. These purpuras induced by external trauma are completely different in their pathophysiology from the senile purpuras, which are benign or occur physiologically in the elderly under the skin or in the oral cavity. Blood vessels, as a natural consequence of aging, usually tend to have a complete lack of support from the underlying connective tissues in which they are embedded. Hence, because these blood vessels have an increased capillary fragility or less resistance, blood pooling and bruising occur more often with increasing age.
What Causes Senile Oral Purpuras?
According to dental research and literature, senile purpura was first described as a condition related to age, though its exact causes are still not completely understood or remain elusive to researchers. However, overall, these purpuras, which are primarily physiologic and result from capillary fragility, are accounted for as a physiologic condition only. Oral ecchymosis, which is the innate discoloration produced when there are small bleeding points at the site of oral injury is usually not encountered as such even on a routine dental examination or on a day-to-day basis. Hence, it necessitates that the dentist examine whether the cause of discoloration or ecchymosis is caused by senile purpuras that may be chronic or long-existing in the oral cavity or whether the purpuras has occurred in the elderly patient as a result of surgical trauma, dental or oral causes, or local infections.
With aging, abnormal macrophage (a type of immune cell involved in detecting and destroying pathogens) functions may contribute to long-term purpuras. A reduction in elastic or collagen fibers with aging can further predispose elderly individuals to external trauma. Chronic usage of certain drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and anticoagulant therapies, can predispose to the development of SP in some cases of the geriatric population groups commonly, some researchers have linked it to zinc-related deficiencies and underlying hepatoportal issues (problems related to the liver and portal vein system) or liver disorders that would be also possibly implicated in SP.
What Are the Clinical Features of Senile Oral Purpuras?
SP presents clinically as purpuric or ecchymotic spots that are painless or non-tender; further, these lesions are nonpalpable ecchymosis forms commonly seen on the palate, tongue, and lips. Ecchymosis discoloration can be noted by dentists usually about the stress-bearing areas of the denture in the mouth, commonly in the palate region in denture wearers or in regions secondary to the palate because of prolonged usage of systemic medications along with the use of dentures in the elderly. Minor trauma from the ill-fitting dentures is also an investigation to be done by the dentist if palatal ecchymosis is present. It is important to differentiate the senile from the traumatic purpura or ecchymosis regions.
How to Diagnose and Manage Senile Oral Purpuras?
Differential diagnosis of the benign senile purpuras (SP) in the oral cavity should be clearly distinguished from similar lesions from serious causes like purpuras arising from myelodysplastic syndrome (a group of disorders caused by poorly formed or dysfunctional blood cells), leukemia (a type of cancer that affects blood and bone marrow), coagulation-related cascade diseases or disorders, or platelet disorders. If the dentist suspects a more serious underlying systemic condition, then interdisciplinary collaboration with the physician would be mandatory to perform more investigations, to rule out possibly underlying serious medical diseases like cancer or chronic-natured blood disorders or conditions. Hematologic (blood) investigations would be required in such cases as a complete hemogram accompanied by peripheral smear examination, liver function tests, prothrombin time (PT), activated partial thromboplastin time (aPTT), INR (international normalized ratio), and serum zinc estimation.
In the case of senile purpura, the above parameters or hematologic tests would be completely normal, and the dentist would rule out any other serious conditions. Dental surgeons should be aware of the natural impact of aging on oral health, just as in the case of systemic health, immunity, and metabolism, which undergo several changes with age. SP, a common oral and dermatologic condition without clinical complications, does not require any specific management protocol. In these cases, the operator's tactility plays an important role. This means that the dentist or surgeon should carefully handle the oral mucosal tissues both during routine examination, or any dental or oral surgical procedures, keeping all the necessary hemostatic measures in place in the dental clinic or setting.
Delicate handling of oral mucosal tissues is crucial to prevent discoloration or ecchymosis linked to senile purpuras. Recent research studies have demonstrated that the citrus bioflavonoid compounds (plant-derived substances that may help reduce inflammation and support blood vessel health) administered orally can be successfully utilized to reduce the episodes of oral purpura and ecchymosis.
Conclusion
To conclude, the dental and medical history elicited by the dentist or oral surgeon plays an important role in differentiating senile oral purpuras from traumatic ones. Gentle handling of oral tissues with adequate hemostatic measures during routine dental procedures can ensure that there are no other clinical implications associated with this aging-related physiologic condition of the oral cavity. When encountering geriatric or elderly cases, all oral physicians, dentists, and maxillofacial surgeons must consider the possibility of SP, which is a benign and harmless condition. Patients should be informed about the importance of maintaining oral hygiene, using chemical or mechanical plaque control measures, and undergoing routine dental prophylaxis every six months to keep their oral health in check.
