Dental Surgery in an Asplenic Patient

Abstract

Nonsurgical endodontic treatment is a highly predictable treatment option in most cases, but surgery may be indicated for teeth with persistent periradicular pathosis unresponsive to it. The persistence of infection usually, but not always, indicates reduced immunological resistance. In such scenario, the clinician should be vigilant and find out the source of immunological incompetence before implementing treatment. Following splenectomy, individuals have an elevated risk of infection, in particular to encapsulated bacteria, Gram-negative pathogens such as Capnocytophagia carnimorsus and Bordetella holmesii, and intra-erythrocyte parasites such as malaria and babesia. After splenectomy, there are alterations in cell counts, cell quality, and immunological responses. Initially, after splenectomy, a reactive thrombocytosis and leukocytosis is observed. Splenectomized individuals are at risk to, overwhelming bacterial sepsis (overwhelming postsplenectomy infection). The complications are now infrequent because of pneumococcal vaccinations, prophylactic penicillin, and prompt medical attention at the first sign of fever. This case presents relevant management of a periradicular lesion in a 32-year-old male who has undergone splenectomy because of idiopathic thrombocytopenic purpura. The tooth was first endodontically treated that was followed by periodontal and periapical surgical treatment.