Dental Treatment of a Child With Histiocytosis

Objectives: Histiocytosis is characterized by an abnormal production of histiocytes. Although bone and mucosae have been classified as non-risk organs, their involvement could increase the risk of disease progression. Therefore, attention has to be paid to periodontal lesions in patients with histiocytosis.
Methods: A six-year-old girl presented with unisystemic, multifocal histiocytosis of the skin. She had pain because of gingival bleeding, and in the lower jaw the teeth were extremely mobile due to periodontal damage. The aim was to treat periodontitis caused by a systemic disease and to prevent tooth extraction. The patient underwent chemotherapy. The dental treatment plan consisted of an individualized oral health prophylaxis with professional tooth cleaning and fluoridation, followed by periodontal therapy with scaling and root planing and rinsing with chlorhexidine. Restorative dental treatment was needed (n=6). A follow-up program for four years involving every-third-month recalls was applied. At the end of chemotherapy, orthodontic treatment was started.
Results: The initial clinical examination showed bleeding on probing for all teeth, and third degree of mobility in the teeth of the mandible. Professional tooth cleaning and periodontal therapy improved the situation, and after six months fewer signs of inflammation were seen. Restorative treatment was done at primary teeth (n=3) and in the second dentition (n=3). At the end of chemotherapy, an orthodontic appliance was inserted. Four years after initial examination, the girl showed a stable oral situation with improvement of gingival and periodontal conditions (no bleeding). Orthodontic treatment and long-term follow-up were continued.
Conclusions: Children with histiocytosis need special dental treatment in close coorperation with oncologists. Especially periodontal health has to be maintained continously. Orthodontic therapy if needed, has to be done cautiously to avoid strong forces due to roots weakened by chemotherapy.