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Forum Name: Pediatric Topics

Question: 4 year old bone loss in mouth


 angel80 - Thu Jan 03, 2008 1:00 am

Where do we go from here?
My daughter started loosing teeth at 18 months due to infections and bone loss in her mouth. After a long process it was discovered that the cause must be an extremely low ANC (<100) at which point she was put on the drug Neupogen. After starting the drug her blood counts have been in a good range (2500) and there was no longer bone loss in her mouth, so after gradually reducing the dose she is now no longer on the drug. 3 months ago the x-rays were fine, 2 months ago she completely stopped the drug, however now she has more bone loss with no infection this time. (She has already lost or had pulled 8 teeth and now the dentist says it looks like she will loose 4 more). Any ideas on what could be going on with her?
 Dr. Chan Lowe - Mon Jan 07, 2008 11:26 pm

User avatar Hi Angel80,

Low ANC is very well described as a predisposing condition for periodontitis that can lead to tooth loss.

I would suggest that the next step is to determine what the cause of her neutropenia was if it has not been determined yet. There may be more that is needed for treatment of this to help every thing heal appropriately.

I would also recommend that your daughter see an oromaxillary specialist. There may be a treatment that can help prevent any further bone loss.

Best wishes.
 angel80 - Mon Jan 07, 2008 11:50 pm

The neutropenia along with her very first teeth falling out (due to infection) is what got us sent to a hematolagist -who did a bone assperation- found no cause for the neutropenia - who then sent us to a geneticist - who did a bone age test- who then sent us to immunolagist who finally decided to actually treat the neutropenia.
They all seem to be at a lose. We will have to look into an oromaxillary speciallist. Thanks for the advice. Any an all help is always appreciated.
 Dr. Chan Lowe - Fri Jan 11, 2008 1:39 am

User avatar Did your hematologist mention cyclic neutropenia? If the bone marrow aspiration was done while the neutrophil count is normal I believe that the bone marrow aspiration being normal does not rule this out. If, by chance, the bone marrow was done just before a neutropenic episode the marrow would show decreased amounts of neutrophil precursors.

This is a little outside my field so I would certainly differ to a pediatric hematologist but I believe the only way to make a diagnosis of cyclic neutropenia is to do repeated CBC's to look at the neutrophil count two to three times per week for four to eight weeks. This allows evaluation for the cyclic dips (which occur about every 3 weeks in the majority of patients). The frequent sampling is needed because the neutropenic period may only last for a few days so it may be missed if the CBC's are done too far apart.

Best wishes.
 angel80 - Fri Jan 11, 2008 2:53 pm

Right after the bone assperation we did three blood draws a week for six weeks. They determined it was not cyclic. They also did tests to determine if she had any of the regular causes for the perialdontal disease like, hypophosphatia. All had very grim outcomes so we were thankful none of those were the cause.
Our immunoligist and dentist have had us put her back on the shot at the dose it was three months ago. They say if it does work and the bone loss stops then they have no idea why but to just do what works and watch for other symptoms.

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