Manifestations and treatment of periodontal disease in a patient suffering from cyclic neutropenia

Abstract

Severe periodontitis in a young man suffering from cyclic neutropenia [characterized by intermittently occurring reduction of the number of neutrophilic granulocytes in the bloodstream and the bone marrow] is reported. The periodontal status determined from oral radiographs at age 13 reveals advanced periodontal breakdown around the molars and the incisors in the jaws. At age 21, when clinical examination was performed, all teeth were periodontally involved. The treatment was divided into 3 phases: a causative treatment phase (oral hygiene phase) aimed at achieving the highest possible level of oral cleanliness, a corrective phase including periodontal surgery and prosthetic rehabilitation and a maintenance phase aimed at preventing recurrence of periodontal disease. The oral hygiene phase was markedly extended in time (2 yr) and intensity. Several reexaminations were carried out during this phase to evaluate the patient''s ability to exercise proper plaque control and the response of the tissues to treatment. The progression of the periodontal disease could be arrested and the prosthetic treatment indicated was successfully performed. Following the corrective treatment phase, a maintenance care program was designed including frequent recall appointments so to prevent recurrence. Four years after active treatment to further periodontal breakdown could be observed as evaluated from pocket depth, attachment level and bone height measurements. Treatment designed to eliminate plaque infection is evidently effective also in an individual with defective host defense against bacterial infections, but the patient''s cooperation must be extraordinarily high to ensure the effectiveness of the maintenance care program.