背景:Felty综合征由三个条件定义:中性粒细胞减少症,类风湿性关节炎,脾肿大.与全血细胞减少相关的中性粒细胞减少症可能进一步影响患者的牙齿状况。Felty综合征患者的牙周治疗和手术需要与血液学家合作。在这里,我们介绍了一例Felty综合征患者,该患者最初因广泛的牙周炎而被转诊到牙科学院附属的口腔外科医院。她与血液科合作得到了有效治疗。
方法:一位55岁的亚裔妇女因担心牙齿活动度恶化而访问我们的部门,不适,和自发性牙龈出血.最初的牙周检查显示,由于白细胞减少/中性粒细胞减少和口腔卫生不良,导致广泛性重度牙周炎(IV级C级)。涉及全面牙科手术的彻底治疗策略,如多次拔除和广泛的假体治疗,已实施。在Felty综合征诊断之后,患者开始口服泼尼松龙40毫克/天,有效控制了疾病。此外,牙周治疗后无重度牙周炎复发。
结论:牙医和医生应该意识到,患有全血细胞减少症和口腔卫生差的免疫受损个体有发展为广泛性牙周炎的风险。如果他们对感染和全血细胞减少相关出血的易感性可以得到控制,这些患者仍然可以接受全面的牙科治疗,包括拔牙和牙周治疗。牙医之间的合作,血液学家,和病人是必要的,以改善治疗结果和病人的生活质量。
BACKGROUND: Felty syndrome is defined by three conditions: neutropenia, rheumatoid arthritis, and splenomegaly. Neutropenia associated with pancytopenia may further affect the dental condition of a patient. Periodontal treatment and surgery in patients with Felty syndrome necessitates cooperation with a hematologist. Here we present a case of a patient with Felty syndrome who was initially referred to the oral surgery hospital attached to the School of Dentistry for extensive periodontitis. She was effectively treated in collaboration with the hematology department.
METHODS: A 55-year-old Asian woman visited our department with concerns of worsening tooth mobility, discomfort, and spontaneous gingival bleeding. Initial periodontal examination revealed generalized severe periodontitis (Stage IV Grade C) resulting from leukopenia/neutropenia and poor oral hygiene. A thorough treatment strategy involving comprehensive dental procedures, such as multiple extractions and extensive prosthetic treatment, was implemented. Following the diagnosis of Felty syndrome, the patient was started on treatment with oral prednisolone 40 mg/day, which effectively controlled the disease. Furthermore, there was no recurrence of severe periodontitis after the periodontal treatment.
CONCLUSIONS: Dentists and physicians should be aware that immunocompromised individuals with pancytopenia and poor oral hygiene are at risk of developing extensive periodontitis. If their susceptibility to infection and pancytopenia-related bleeding can be managed, such patients can still receive comprehensive dental treatment, including teeth extractions and periodontal therapy. Cooperation among the dentist, hematologist, and patient is necessary to improve treatment outcomes and the patient\'s quality of life.