Pulp Obliteration in a Patient with Sclerodermatous Chronic Graft-versus-Host Disease

J Endod. 2016 Apr;42(4):678-80. doi: 10.1016/j.joen.2016.01.009. Epub 2016 Feb 20.

Abstract

Dental pulp calcification is a common finding associated with localized dental trauma, genetic disorders, and systemic inflammatory diseases. Chronic graft-versus-host disease (cGVHD) is a frequent complication after allogeneic hematopoietic cell transplantation (allo-HCT) characterized by immune-mediated injury to the skin, mouth, eyes, liver, and other tissues, resulting in significant disability and reduced quality of life. We report a patient with sclerodermatous cGVHD who presented with general pulp calcification in all teeth 5 years after allo-HCT. A review of full mouth dental radiographs obtained just before allo-HCT revealed normal-appearing pulp chambers. Based on prior reports of generalized pulp calcification associated with progressive systemic sclerosis, we hypothesized that the etiology was likely related to the presence of cGVHD with associated vascular and fibrotic tissue changes within the pulp vasculature. Clinicians should consider cGVHD in the differential diagnosis of generalized pulp calcification.

Keywords: Allogeneic hematopoietic cell transplantation; dental pulp obliteration; oral chronic graft-versus-host disease; pulp calcification.

Publication types

  • Case Reports

MeSH terms

  • Chronic Disease
  • Dental Pulp / pathology*
  • Endothelium, Vascular / abnormalities
  • Graft vs Host Disease / blood
  • Graft vs Host Disease / immunology
  • Graft vs Host Disease / pathology*
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Humans
  • Inflammation / blood
  • Inflammation / immunology
  • Inflammation / pathology
  • Male
  • Middle Aged
  • Scleroderma, Systemic / blood
  • Scleroderma, Systemic / immunology
  • Scleroderma, Systemic / pathology
  • Tooth Calcification