Abstract
BackgroundAplastic 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.Case presentationA 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.ConclusionsBoth 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.
Highlights
Aplastic anemia is an intractable disease characterized by pancytopenia, susceptibility to infection, and difficulty in achieving hemostasis
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
Aplastic anemia (AA) is an intractable hematologic disease characterized by empty bone marrow that results in pancytopenia with decreased levels of platelets, white blood cells, and erythrocytes [1, 2]
Summary
Pancytopenia accompanied by poor oral hygiene condition can induce severe periodontitis. When both diseases are present, close medical and dental cooperation is required to prevent life-threatening events and improve the patient’s quality of life. The present case suggests that, when local hemostatic measures have been adequately applied, a platelet count of 20,000 is sufficient to perform invasive dental procedures without the need for platelet transfusions. Further validation and additional case reports are required to verify this assumption. Even if the patient has AA and severe chronic periodontitis, comprehensive dental treatment including tooth conservation, extraction surgery, orthodontic treatment, and
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