Arresting rampant dental caries with silver diamine fluoride in a young teenager suffering from chronic oral graft versus host disease post-bone marrow transplantation: a case report

Chun-Hung Chu, Angeline Hui-Cheng Lee, Liwu Zheng, May Lei Mei, Godfrey Chi-Fung Chan, Chun-Hung Chu, Angeline Hui-Cheng Lee, Liwu Zheng, May Lei Mei, Godfrey Chi-Fung Chan

Abstract

Background: Rampant caries is an advanced and severe dental disease that affects multiple teeth. This case describes the management of rampant caries in a young teenager suffering from chronic oral graft versus host disease after allogeneic bone marrow transplantation.

Case presentation: A 14-year-old Chinese boy suffering from β-thalassemia major was referred to the dental clinic for the management of rampant dental caries. An oral examination revealed pale conjunctiva, bruising of lips, and depapillation of tongue indicating an underlying condition of anemia. The poor oral condition due to topical and systemic immunosuppressants was seriously aggravated, and rampant caries developed rapidly, affecting all newly erupted, permanent teeth. The teeth were hypersensitive and halitosis was apparent. Strategies for oral health education and diet modification were given to the patient. Xylitol chewing gum was used to stimulate saliva flow to promote remineralization of teeth. Silver diamine fluoride was topically applied to arrest rampant caries and to relieve pain from hypersensitivity. Carious teeth with pulpal involvement were endodontically treated. Stainless steel crowns were provided on molars to restore chewing function, and polycarbonate crowns were placed on premolars, upper canines and incisors.

Conclusion: This case report demonstrates success in treating a young teenager with severe rampant dental decay by contemporary caries control and preventive strategy.

Figures

Figure 1
Figure 1
Full face photo.
Figure 2
Figure 2
Pale conjunctiva.
Figure 3
Figure 3
Bruising of the lips.
Figure 4
Figure 4
Depapillation of the tongue.
Figure 5
Figure 5
Pre-treatment intra-oral frontal view.
Figure 6
Figure 6
Pre-treatment upper occlusal view.
Figure 7
Figure 7
Pre-treatment lower occlusal view.
Figure 8
Figure 8
Pre-treatment left buccal view.
Figure 9
Figure 9
Pre-treatment right buccal view.
Figure 10
Figure 10
Pre-treatment panoramic radiograph.
Figure 11
Figure 11
Pre-treatment periapical radiographs.
Figure 12
Figure 12
Front view after SDF treatment.
Figure 13
Figure 13
Upper occlusal view after SDF treatment.
Figure 14
Figure 14
Lower occlusal view after SDF treatment.
Figure 15
Figure 15
Left buccal view after SDF treatment.
Figure 16
Figure 16
Right buccal view after SDF.
Figure 17
Figure 17
Frontal view after provisional crowns treatment.
Figure 18
Figure 18
Upper occlusal view after provisional crowns treatment.
Figure 19
Figure 19
Lower occlusal view after provisional crowns treatment.
Figure 20
Figure 20
Left buccal view after provisional crowns treatment.
Figure 21
Figure 21
Right buccal view after provisional crowns treatment.
Figure 22
Figure 22
Smile photo after provisional crowns treatment.
Figure 23
Figure 23
Post-endodontic treatment panoramic radiograph.

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Source: PubMed

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