Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Watanabe Orthodontic Office, 1-11-26-2F Kichijoji-honcho, Musashino-shi, Tokyo, 180-0004, Japan.
J Med Case Rep. 2021 Dec 10;15(1):581. doi: 10.1186/s13256-021-03170-0.
Aplastic anemia is an intractable disease characterized by pancytopenia, susceptibility to infection, and difficulty in achieving hemostasis. In patients with severe periodontal disease and aplastic anemia, spontaneous bleeding from the gingival tissue due to thrombocytopenia and during brushing is common, which may further exacerbate dental issues. Comprehensive periodontal treatment for patients with aplastic anemia is highly challenging and requires collaboration with a hematologist. Here, we discuss the case of a patient with aplastic anemia and severe periodontitis who was successfully treated in collaboration with our hematology department.
A 36-year-old Japanese woman with chief complaints of spontaneous gingival bleeding, pain, and increasing tooth mobility consulted our department. She had developed pancytopenia at age 11 years and was later diagnosed with aplastic anemia, making her susceptible to infection due to leukopenia. The results of the initial periodontal examination led to a diagnosis of severe generalized periodontitis (generalized stage IV grade C periodontitis) caused by leukopenia and poor oral hygiene. We adopted a comprehensive treatment plan, including invasive dental procedures. The patient exhibited no postoperative bleeding due to aplastic anemia-induced thrombocytopenia and experienced a good outcome.
Both physicians and dentists should be aware that immunocompromised patients with aplastic anemia are at risk of developing severe periodontitis with severe alveolar bone resorption if the condition is combined with poor oral hygiene. Even in the presence of aplastic anemia, patients with severe periodontitis can undergo comprehensive dental treatment, including dental extraction and periodontal surgery, if bleeding and susceptibility to infection are controlled. This requires the cooperation of the patient and hematologists and can ultimately contribute to improving the patient's quality of life.
再生障碍性贫血是一种难治性疾病，其特征为全血细胞减少、易感染和止血困难。患有严重牙周病和再生障碍性贫血的患者，由于血小板减少和刷牙时牙龈组织自发性出血较为常见，这可能会进一步加重牙齿问题。再生障碍性贫血患者的综合牙周治疗极具挑战性，需要与血液科医生合作。在此，我们讨论了一例与血液科合作成功治疗的再生障碍性贫血伴严重牙周炎患者。
一名 36 岁的日本女性，主要症状为自发性牙龈出血、疼痛和牙齿松动度增加，到我院就诊。她在 11 岁时出现全血细胞减少，后来被诊断为再生障碍性贫血，使她因白细胞减少而容易感染。初步牙周检查结果诊断为严重的广泛牙周炎（广泛的 IV 期 C 级牙周炎），由白细胞减少和口腔卫生不良引起。我们采用了综合治疗计划，包括侵入性牙科程序。由于再生障碍性贫血引起的血小板减少，该患者无术后出血，且预后良好。
医生和牙医都应该意识到，如果再生障碍性贫血患者免疫功能低下，同时伴有口腔卫生不良，可能会发展为严重的牙周炎，伴有严重的牙槽骨吸收。即使存在再生障碍性贫血，如果控制了出血和感染易感性，患有严重牙周炎的患者仍可接受包括拔牙和牙周手术在内的综合牙科治疗。这需要患者和血液科医生的合作，最终有助于提高患者的生活质量。
