週期性嗜中性白血球減少症之牙科治療－病例報告

Dental Management of Cyclic Neutropenia: Report of a Case

廖桂君(Kuei-Chun Liao) ； 項家蘭(Chia-Lan Hsiang) ； 謝承祐(Chen-Yu Hsieh) ； 郭倍榮(Bey-Rong Guo) ； 王錦莉(Jinn-Li Wang) ； 羅怡君(Yi-June Lo)

《臺灣兒童牙醫學雜誌》 9卷1期 (2009/04) Pp. 13-20

https://doi.org/10.6319/TJPD.2009.9(1).3

摘要

週期性嗜中性白血球減少症是一種自體顯性的遺傳疾病，並沒有性別上的差異，血液學檢查可發現嗜中性白血球數量會呈現一個週期性波動，平均約21天。患者在嗜中性白血球減少期易出現感染現象，包括上呼吸道感染、中耳炎、再發性發燒、表皮潰瘍等，口內則會出現牙齦炎、口腔潰瘍、牙周病情況。本病例為一9歲10個月的男孩，因經常性牙齦紅腫及刷牙流血被轉診至本院求診，經由臨床、X光片及血液學等檢查診斷為週期性嗜中性白血球減少症合併全口牙周病。在每次牙科治療前檢測其嗜中性白血球數量，如果絕對嗜中性球白血球值(absolute neutrophil count: ANC)小於1000(×1/μL)則給予預防性抗生素，術後再給予口服抗生素，使用三天；如果ANC小於500(×1/μL)，則暫緩所有牙科治療直到ANC上升。施行基本牙周治療包括口腔衛教、牙菌斑控制、全口洗牙，以及使用0.2% chlorhexidine漱口水，一天兩次，並定期追蹤回診以減緩病人牙周組織的破壞。目前患者定期回兒童牙科追蹤，每次回診口腔衛生大致良好，但局部輕度到中度牙齦發炎仍可見到。此患者雖有雙顎齒槽前突及前牙深咬情況而需矯正治療，但矯正的作用力及口腔清潔的難維持，都可能加速牙周組織的破壞，故建議矯正治療應延後至患者病況穩定後再評估。

關鍵字

週期性嗜中性白血球減少症 ； 牙周病 ； 抗生素預防感染

並列摘要

Cyclic neutropenia is an inherited autosomal dominant disease without sexual difference. Periodic oscillations of neutrophil count can be observed in the blood examination with a mean duration of 21 days. Patient is subjected to infection during the neutropenic phase, including upper respiratory infection, otitis media, recurrent fever, cutaneous ulcers, and oral features include gingivitis, oral ulcers, and periodontitis. This 9 years 10 months old boy was referred to our hospital because of gingival swelling and bleeding, and was diagnosed as periodontitis compromised with cyclic neutropenia after clinical, radiographic, and blood examination. The patient was checked the amount of the neutrophil before every dental treatment. If the ANC (absolute neutrophil count) is below 1000(×1/µL), the antibiotic prophylaxis will be needed, and the maintain dose of oral antibiotics also be described for 3 days after dental procedure. If the ANC is below 500(×1/µL), we defer the dental care until the ANC rises. We performed the basic periodontal treatments, included oral hygiene instruction, plaque control, full-mouth scaling, mouthrinse with 0.2% chlorhexidine 2 times per day, and periodic follow-up to decrease the periodontal breakdown of this patient. Patient return to pediatric dentistry for regular checkup now, and the oral hygiene is fair but mild to moderate gingival inflammation was still noted in every check-up. The patient was diagnosed as bimaxillary protrusion and anterior deep bite, but the orthodontic treatment should be delayed until the stable of the periodontal status and be evaluated again because the orthodontic force and the poor oral hygiene may accelerate the breakdown of the periodontal tissue.

並列關鍵字

cyclic neutropenia ； periodontitis ； antibiotic prophylaxis