Severe Periodontal Destruction In Langerhans Cell Histiocytosis: A Multidisciplinary Challenge

Although oral manifestations of Langerhans cell histiocytosis (LCH) are uncommon, periodontal lesions—characterized by gingival erythema, tooth mobility, and extensive alveolar bone resorption—emerge as a hallmark feature of the disease. These severe clinical presentations are frequently mistaken for conventional periodontitis, resulting in delayed diagnosis and treament. Here, we report a case of catastrophic oral destruction in a young patient with LCH, highlighting the critical need for early identification, systematic interdisciplinary collaboration. A 21-year-old female with LCH (Lavin-Osband grade 2, level III) presented with progressive tooth loss, trismus, and facial asymmetry. Oral examination revealed mucosal adhesions, severe alveolar bone resorption (78% teeth “floating”), and poor hygiene. Genetic testing identified mutations in PAH, KIT, TMEM127, and ZFHX3. A staged treatment included: a) quadrant-specific extractions to minimize surgical trauma, b) rigorous periodontal therapy for salvageable teeth, c) laser ablation of dense fibrous adhesions, and d) customized removable dentures post-healing. The quadrant-wise extraction minimized surgical trauma, while laser therapy effectively addressed adhesions without scarring. Retaining key teeth preserved occlusal function during rehabilitation. Genetic insights guided systemic management. This approach balanced disease control, functional restoration, and patient adaptability. This report highlights the critical role of a tailored, multidisciplinary strategy in addressing severe LCH-associated oral lesions. The integration of staged surgical interventions, advanced laser technology, and prosthodontic rehabilitation not only mitigated morbidity but also restored oral function, offering a paradigm for managing complex, rare disorders with systemic-oral interplay.