Conservative Management of a Primary Mandibular Second Molar With Dentoalveolar Abscess in a Four-Year-Old Child With Acute Lymphoblastic Leukemia: A Case Report.

Acute lymphoblastic leukemia (ALL) is the most common pediatric hematologic malignancy and is frequently associated with significant oral complications resulting from the disease as well as the treatment-related immunosuppression. In such conditions, odontogenic infections may progress rapidly and contribute to systemic morbidity, thereby necessitating proper and carefully coordinated dental management. A four-year-old boy diagnosed with ALL, in the maintenance phase of chemotherapy, presented with pain and swelling in the lower right back tooth region for five days. Clinical and radiographic examination revealed a dentoalveolar abscess associated with the right deciduous mandibular second molar, along with multiple carious lesions involving other teeth. Following consultation with the pediatric oncologist and assessment of hematological parameters, a comprehensive dental rehabilitation was performed under strict infection control measures. Treatment included a pulpectomy of the right deciduous mandibular second molar, followed by placement of a stainless-steel crown and restorative management of other carious lesions. The child demonstrated complete resolution of pain and swelling, preservation of the affected primary tooth, restoration of masticatory function, and significant improvement in oral health during the follow-up visits. No postoperative complications or interruption of ongoing chemotherapy occurred. This case highlights that conservative management of an infected primary molar can be considered and safely done in children with ALL if their medical condition and hematological status permit. Also, careful treatment planning and multidisciplinary coordination with the oncologist allowed elimination of the oral foci of infection while preserving the teeth and maintaining arch integrity.