A case of
periodic neutropenia with specific symptoms of gingiva and
alveolar bone loss in primary dentition is reported. The patient was a boy, and it was followed between the ages of 3- and 9 years-old. At the period of
neutropenia he was suffered from recurrent redness, swelling and
bleeding of the gingiva, and also with cold-like symptoms with
fever. Although the cause of these symptoms was not definite at first, even in medical exploration, we could diagnose this disease as
periodic neutropenia by the process of dental
therapy. By alveolar
bone resorption, pocket formation and severe
tooth mobility, the patient had lost more than half of his primary teeth at the end of 2 years after the initial examination. However throughout this period we motivated and instructed the patient and his mother how to brush his teeth. His
oral hygiene was improved in the mixed and permanent dentition stages. Then there was no evidence of
bone resorption around the teeth of the permanent dentition stage, but recurrent gingival symptoms are continuing now. The specific feature of this case is found in the gingival findings. There was no ulceration of the oral mucosa, but a bright red jelly-like appearance was found periodically in the area of the marginal and attached gingiva. The junction between the reddened attached gingiva and the alveolar mucosa was well-defined. The serial examination of peripheral blood in this case revealed the cycle of
neutropenia as 16 to 21 days. During this examination, and at the almost time of
neutropenia of this patient,
hyperplasia of monocytes and lymphocytes occurred. In this situation there was no clinical signs except for gingival redness. However at other times, generally marked signs were recurrent. This may have occurred due to the lack of both neutrophils and monocytes. From the above results we think that
periodic neutropenia may be diagnosed first in the dental clinic by the distinctive redness in the gingival area as one specific sign of this disease. We also think that plaque control procedures may retain the teeth.