エブスタイン奇形の患者の自力抜歯後の脳膿瘍：症例報告

Cerebral abscess following the self-extraction of teeth in patient with Ebstein's anomaly: a case report.

• Soichiro Kawase
• Yoshiyuki Okada
• Kazushige Isono
• Hitoshi Iwasaki
• Takashi Kuno
• Kohei Matsumura
• Yiwen Fu
• Yorikazu Harada
• Tadashi Ogasawara

抄録

背景:

感染性心内膜炎のリスクが高い患者には、抜歯を含む侵襲的治療の前に抗生物質による予防を行うことが依然として推奨されている。しかし，知的障害のある患者の日常生活における自己抜歯によるリスクは不明である。

BACKGROUND: Antibiotic prophylaxis before invasive treatments, including dental extractions, is still recommended for patients at high risk of infective endocarditis. However, the risk from self-extraction of teeth in daily life of patients with intellectual disabilities is uncertain.

症例提示:

6歳のEbstein異常の患者が脳膿瘍を発症し，歯由来の感染性心内膜炎と関連しているように見えた。乳歯の自己抜歯から2週間後，耳に痛みを感じるようになり，継続的な発熱が生じ，その後，嘔吐，顔面痙攣，意識消失が生じた。2ヶ月間入院し、抗生物質の点滴と脳へのドレナージチューブの投与を受けた。

CASE PRESENTATION: A 6-year-old patient with Ebstein's anomaly developed cerebral abscess, which appeared associated with infective endocarditis of dental origin. Two weeks after self-extraction of his deciduous teeth, he began to experience pain in his ear and developed continuous fever, followed by vomiting, facial spasm, and a loss of consciousness. He was admitted into a hospital for 2 months, during which he received intravenously administered antibiotics and a drainage tube in his brain.

おわりに:

知的障害者の乳歯は、歯根吸収や自然脱落の前に自己抜歯することができる。感染性心内膜炎のリスクが高く、可動性乳歯を頻繁に触る場合には、自然脱落を待つのではなく、抗生物質の予防投与で早期に抜歯することも選択肢の一つであると思われる。

CONCLUSIONS: Deciduous teeth can be self-extracted before root resorption and natural shedding in patients with intellectual disabilities. When they are at high risk of infective endocarditis and frequently touch mobile deciduous teeth, it seems to be an option to extract the teeth early with antibiotic prophylaxis, rather than to wait natural fall.