key: cord-0998709-qaj533pa
authors: Gilligan, Gerardo M; Piemonte, Eduardo D; Lazos, Jeronimo P; Panico, Rene L
title: In reply to the letter to the editor "Tele(oral)medicine: A new approach during the COVID‐19 crisis"
date: 2020-05-31
journal: Oral Dis
DOI: 10.1111/odi.13454
sha: 91b155c6e3a4fc22ef959e8c1214caf464a21a15
doc_id: 998709
cord_uid: qaj533pa

We would like tocongratulate Villa et al fora recent published letter to the editor(Villa et al; 2020), emphasizing the use of tele(oral)medicine as an effective diagnostic tool(Estai et al, 2018),which could be usefulin the current time of crisis.The COVID‐19 pandemic, and the social isolation measures mandatedby health authorities haveled toa reassessing of the professional practicesin our Dental College.

purpura Dear Editor, We would like tocongratulate Villa et al fora recent published letter to the editor (Villa et al; 2020) , emphasizing the use of tele(oral)medicine as an effective diagnostic tool (Estai et al, 2018) ,which could be usefulin the current time of crisis.The COVID-19 pandemic, and the social isolation measures mandatedby health authorities haveled toa reassessing of the professional practicesin our Dental College.

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We report a case reflecting a suitableuse of telemedicinein Oral Medicine. A general dental practitioner, working in a small Patagonian village (more than 1,000 km away from our institution), referredus a case usingInstagram and WhatsApp. It was a 7-year-old female with chief complaint of spontaneous gingival bleeding, with no previous medical conditions.

The clinical pictures sentshowed multiple haemorrhagic bullae, petechial lesions, and gingival bleeding (Figure 1) . A thoroughanamnesis was performed remotely, where previous febrile episodes and generalized weakness were recorded.The provisional diagnoses were haematological conditions such as leukemia, idiopathic thrombocytopenic purpura (ITP) andhaemorrhagic dengue. The last one was also considered due to an increased number in dengue cases in our country (Ayala et al, 2020) . Weasked fora full blood count of the child, whichrevealed a severe thrombocytopenia with a platelet count of less than 10,000 platelets per microliter, withother values withinnormal limits. Thus, an urgent referral to haematology was indicated, where ITP with oral involvement was diagnosed.

The quarantine allowed us to distinguishtele(oral)medicine as a remote diagnostic method to help patients with oral diseases. However, arational use should be encouraged, recognizing itslimitations. On that regard, from our experience one the most important drawback is the lack of tactile assessment. In agreement with Villa et.al., we believe thatfuture research efforts should address Telemedicine as a diagnostic method, also consideringrelevant issues such as the quality of the photographic record, legal,remunerative aspects, and others. 

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Tele(oral)medicine: A new approach during the COVID-19 crisis. Oral Diseasesn/a

The authors would like to thank Dr Sebastián Ezequiel Morales for the referral of the case by telemedicine.

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