Background and Introduction: The transition from acute local inflammation following wisdom tooth surgery to a chronic stage of "Silent Inflammation" could be a neglected cause of unexplained medical conditions.
Case Report: Here we will refer to an unusual case of recurrent syncope in a 19-year-old woman whose 12 months of treatment in various clinics, and wide range of prescribed medications, failed to bring about any improvement in her condition.
Material and Methods: As previous analyses of the cytokine profile in fatty-degenerative osteonecrosis of the jawbone (Fdoj) show local overexpression of the chemokine Rantes/Ccl-5 (R/C), this case further supports the suspicion of a chronic inflammatory process.
Results: Stepwise surgical removal of Fdoj areas containing insufficiently healed, osteonecrotic medullary cavities resulted in the permanent cessation of syncope episodes by removing local sources of r/c.
Discussion: Following a study of the relevant literature on the effects of chemokines in the central nervous system (Cns), We focus here on the interconnected disease pathways of peripheral R/C overexpression and disorders of the Cns. A change in peripheral immune regulation in the jaw provokes a chronically aggressive immune response in the Cns. If both systems fail to resume normal functioning, this maladaptation results in a dire neurological response pattern in this young patient.
Conclusion: The incomplete wound healing and associated "Silent Inflammation" in the jawbone may contribute via peripheral, local R/c overexpression to various symptoms in the Cns which are typical of chemokine's. From a systemic perspective, we recommend that more attention be paid to this cytokine cross-talk in medicine and dentistry.
Keywords: Rantes/Ccl5, Fatty-Degenerative Osteonecrosis of the Jawbone, Syncope, Central Nervous System, Cytokine Cross-Talk, Silent Inflammation