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Mizutani-Yoshimura M, Mizutani S, Uchida N, Taniguchi S, Fueki K. Do oral conditions influence the incidence of bloodstream infection after hematopoietic stem cell transplantation? A retrospective study in Japan. Support Care Cancer 2024; 32:398. [PMID: 38819687 DOI: 10.1007/s00520-024-08609-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/26/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE This study aimed to evaluate the incidence of bloodstream infection (BSI) among patients undergoing hematopoietic stem cell transplantation (HSCT) for teeth indicated for extraction. METHODS Patients who underwent HSCT at Toranomon Hospital (Tokyo, Japan) between January 2017 and December 2019 were retrospectively evaluated. The incidence of BSI among patients with teeth indicated for extraction who did not undergo extraction (oral high-risk group) and patients who did not have this risk (oral low-risk group) was compared. RESULTS Among the 191 consecutive patients included in this study, 119 patients were classified as undergoing high-risk transplantation. BSI after HSCT was observed in 32 out of 60 (53.3%) patients and 56 out of 131 (42.7%) patients in the oral low-risk and oral high-risk groups, respectively (p = 0.173). Multivariable analyses revealed that the presence of > 3 teeth as intraoral sources of infection and age over 50 years were determinants of BSI originating from the oral cavity after engraftment (odds ratio [OR], 9.11; 95% confidential interval [CI] 2.27-36.61]; p = 0.002; OR, 3.22; CI [1.47-7.08], p = 0.004, respectively). CONCLUSION In patients undergoing HSCT, the presence of less than three intraoral sources of infection did not affect the incidence of BSI after HSCT.
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Affiliation(s)
| | - Saneyuki Mizutani
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koutoubashi Sumida-Ku, Tokyo, 130-8575, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon Minato-Ku, Tokyo, 105-8470, Japan
| | - Shuichi Taniguchi
- Department of Hematology, Hamanomachi Hospital, 3-3-3 Nagahama Chuou-Ku, Fukuoka, 810-0072, Japan
| | - Kenji Fueki
- Department of Masticatory Function and Health Science, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-Ku, Tokyo, 113-8510, Japan
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Śledzińska A, Śledzińska P, Bebyn M, Komisarek O. Title: Chemotherapy-Induced Oral Complications and Prophylaxis Strategies. Cancer Invest 2023:1-24. [PMID: 36892292 DOI: 10.1080/07357907.2023.2188558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Cancer is currently a significant therapeutic challenge and is frequently connected with numerous adverse effects. Despite many improvements in chemotherapy, oral complications are common, leading to poor quality of life and chemotherapeutic dose reduction, which impair survival. This review summarizes the most common dental complications in patients receiving chemotherapy. We mainly focus on oral mucositis as it is a major cause of dose-limiting toxicity. Furthermore, oral candidiasis, viral infections, and xerostomia will be discussed. Conclusions: preventing complications is significantly more important than treating them. All patients beginning systemic anticancer treatment should undergo a thorough oral examination and get appropriate prophylaxis.
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Affiliation(s)
- Aleksandra Śledzińska
- Faculty of Medicine, Poznan University of Medical Sciences, Fredry 10, 61-701 Poznań, Poland
| | - Paulina Śledzińska
- Molecular Oncology and Genetics Department, Innovative Medical Forum, The F. Lukaszczyk Oncology Center, 85-796 Bydgoszcz, Poland
| | - Marek Bebyn
- Molecular Oncology and Genetics Department, Innovative Medical Forum, The F. Lukaszczyk Oncology Center, 85-796 Bydgoszcz, Poland
| | - Oskar Komisarek
- Department of Maxillofacial Orthopedics and Orthodontics, Fredry 10, 61-701 Poznań University of Medical Sciences, Poznan, Poland
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3
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Morikawa S, Watanabe K, Usuda S, Miyashita Y, Nakagawa T. Proposed protocol for treatment of severe periodontitis without platelet transfusion in patients with aplastic anemia: a case report. J Med Case Rep 2021; 15:581. [PMID: 34893080 PMCID: PMC8665541 DOI: 10.1186/s13256-021-03170-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/21/2021] [Indexed: 12/05/2022] Open
Abstract
Background Aplastic anemia is an intractable disease characterized by pancytopenia, susceptibility to infection, and difficulty in achieving hemostasis. In patients with severe periodontal disease and aplastic anemia, spontaneous bleeding from the gingival tissue due to thrombocytopenia and during brushing is common, which may further exacerbate dental issues. Comprehensive periodontal treatment for patients with aplastic anemia is highly challenging and requires collaboration with a hematologist. Here, we discuss the case of a patient with aplastic anemia and severe periodontitis who was successfully treated in collaboration with our hematology department. Case presentation A 36-year-old Japanese woman with chief complaints of spontaneous gingival bleeding, pain, and increasing tooth mobility consulted our department. She had developed pancytopenia at age 11 years and was later diagnosed with aplastic anemia, making her susceptible to infection due to leukopenia. The results of the initial periodontal examination led to a diagnosis of severe generalized periodontitis (generalized stage IV grade C periodontitis) caused by leukopenia and poor oral hygiene. We adopted a comprehensive treatment plan, including invasive dental procedures. The patient exhibited no postoperative bleeding due to aplastic anemia-induced thrombocytopenia and experienced a good outcome. Conclusions Both physicians and dentists should be aware that immunocompromised patients with aplastic anemia are at risk of developing severe periodontitis with severe alveolar bone resorption if the condition is combined with poor oral hygiene. Even in the presence of aplastic anemia, patients with severe periodontitis can undergo comprehensive dental treatment, including dental extraction and periodontal surgery, if bleeding and susceptibility to infection are controlled. This requires the cooperation of the patient and hematologists and can ultimately contribute to improving the patient’s quality of life.
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Affiliation(s)
- Satoru Morikawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kazuya Watanabe
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Watanabe Orthodontic Office, 1-11-26-2F Kichijoji-honcho, Musashino-shi, Tokyo, 180-0004, Japan
| | - Satoshi Usuda
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoko Miyashita
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taneaki Nakagawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Karasneh J, Christoforou J, Walker JS, Manfredi M, Dave B, Diz Dios P, Lockhart PB, Patton LL. World Workshop on Oral Medicine VII: Platelet count and platelet transfusion for invasive dental procedures in thrombocytopenic patients: A systematic review. Oral Dis 2019; 25 Suppl 1:174-181. [DOI: 10.1111/odi.13082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/14/2019] [Accepted: 02/27/2019] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - Jennifer S. Walker
- Health Sciences Library University of North Carolina Chapel Hill North Carolina
| | | | - Bella Dave
- Department of Oral Medicine Leeds Dental Institute Leeds, West Yorkshire UK
| | - Pedro Diz Dios
- Medical‐Surgical Dentistry Research Group (OMEQUI) Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela Spain
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5
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Abed H, Alhabshi M, Alkhayal Z, Burke M, Nizarali N. Oral and dental management of people with myelodysplastic syndromes and acute myeloid leukemia: A systematic search and evidence‐based clinical guidance. SPECIAL CARE IN DENTISTRY 2019; 39:406-420. [DOI: 10.1111/scd.12384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/27/2019] [Accepted: 04/23/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Hassan Abed
- Department of Sedation and Special Care DentistryGuy's Hospital London United Kingdom
- Department of Basic and Clinical Oral SciencesFaculty of Dentistry, Umm Al‐Qura University Makkah Saudi Arabia
| | - Manaf Alhabshi
- Department of Oral and Maxillofacial SurgeryKing Faisal Specialist Hospital Makkah Saudi Arabia
| | - Zikra Alkhayal
- Department of DentistryKing Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia
| | - Mary Burke
- Department of Sedation and Special Care DentistryGuy's Hospital London United Kingdom
| | - Najla Nizarali
- Department of Sedation and Special Care DentistryGuy's Hospital London United Kingdom
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Shimada Y, Nakagawa Y, Ide K, Sato I, Hagiwara S, Yamada H, Kawasaki Y, Maruoka Y. Importance of eliminating potential dental focal infection before the first cycle of chemotherapy in patients with hematologic malignancy. Support Care Cancer 2017; 25:1379-1381. [PMID: 28239744 PMCID: PMC5378740 DOI: 10.1007/s00520-017-3643-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 02/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Yasuyuki Shimada
- Department of Oral and Maxillofacial Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan. .,Department of Drug Evaluation and Informatics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan.
| | - Yumiko Nakagawa
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazuki Ide
- Department of Drug Evaluation and Informatics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan.,Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Center for the Promotion of Interdisciplinary Education and Research (C-PIER), Kyoto University, Kyoto, Japan
| | - Izumi Sato
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan
| | - Shotaro Hagiwara
- Division of Hematology, Department of Internal Medicine, Center Hospital of the National Medical Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Drug Evaluation and Informatics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yohei Kawasaki
- Department of Drug Evaluation and Informatics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan.,Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Yutaka Maruoka
- Department of Oral and Maxillofacial Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.,Oral and Maxillofacial Surgery, Department of Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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Fillmore WJ, Leavitt BD, Arce K. Dental extraction in the neutropenic patient. J Oral Maxillofac Surg 2014; 72:2386-93. [PMID: 25218884 DOI: 10.1016/j.joms.2014.06.443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 06/17/2014] [Accepted: 06/17/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To identify risks of dental extraction in patients with mild, moderate, and severe neutropenia. MATERIALS AND METHODS The authors undertook an observational study of 116 patients diagnosed with neutropenia and undergoing dental extractions in the Mayo Clinic Division of Oral and Maxillofacial Surgery. Absolute neutrophil count (ANC) was no higher than 1,500/μL. Predictors were ANC, age, diagnosis, number of teeth removed, type and location of extraction, length of antibiotic use, presence and type of bacteremia at the time of consultation or extraction, reason for consultation, indication for extraction, and use of any granulocyte colony-stimulating factor (GCSF). Primary outcomes were total complications, surgical site infections, delayed healing, and prolonged postoperative pain. Descriptive and bivariate analyses were undertaken, with statistical significance set at a P value less than or equal to .05. RESULTS One hundred sixteen patients underwent extraction while neutropenic. The overall complication rate was 8.6% (n=10). All were minor complications requiring simple interventions, if any. Complications were delayed healing, surgical site infection, and prolonged postoperative pain. Delayed healing was not associated with ANC. GCSF and related medications did not appear to affect outcomes in these patients. CONCLUSION The results of this preliminary study suggest that extraction of teeth in patients at all stages of neutropenia can be conducted safely. Complications of extraction were few and should be easily controlled. Further studies are required to clarify and stratify risk for future patients.
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Affiliation(s)
- W Jonathan Fillmore
- Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
| | - Bryce D Leavitt
- Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Kevin Arce
- Consultant and Instructor in Surgery, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
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8
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Fillmore WJ, Leavitt BD, Arce K. Dental extraction in the thrombocytopenic patient is safe and complications are easily managed. J Oral Maxillofac Surg 2013; 71:1647-52. [PMID: 23932116 DOI: 10.1016/j.joms.2013.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize bleeding risk and management of bleeding in thrombocytopenic patients undergoing dental extraction. MATERIALS AND METHODS This retrospective cohort study included 68 patients with hematologic disease and concomitant thrombocytopenia undergoing dental extractions. The inclusion criterion was a platelet count of 100,000/μL or less at the time of consultation or extraction. Patients using anticoagulation therapy were excluded from the study. Predictors measured were age, gender, platelet count, platelet transfusion before or during surgery, local hemostatic measurements at the time of surgery (absorbable hemostat or antifibrinolytic rinse), number of teeth extracted, diagnosis, and extraction type. The primary outcome was postoperative bleeding requiring intervention. A secondary outcome was surgical site infection. Descriptive and bivariate statistics were computed and the P value was set at .05. No logistic regression was used based on the distribution of outcomes. RESULTS Sixty-eight patients underwent extraction of 200 teeth. Five (7.4%) had postoperative bleeding that was always controlled with routine intervention. Mean platelet count was 44,647/μL. Bleeding was more frequent with lower platelet levels (P = .048). Thirty-two patients received platelet transfusion and 26 received local measures. Platelet transfusion and local hemostatic measures had no effect on bleeding outcomes. CONCLUSION Surgical and routine extractions are safe procedures in patients with thrombocytopenia, and postoperative bleeding is typically well handled with simple local measures. The benefits of pre- or intraoperative platelet transfusion are unclear in this population. Likewise, the benefit of prophylactic local hemostatic measures is unclear and should be based on the surgeon's discretion and experience.
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Affiliation(s)
- W Jonathan Fillmore
- Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
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9
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Palmason S, Marty FM, Treister NS. How Do We Manage Oral Infections in Allogeneic Stem Cell Transplantation and Other Severely Immunocompromised Patients? Oral Maxillofac Surg Clin North Am 2011; 23:579-99, vii. [DOI: 10.1016/j.coms.2011.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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10
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Leavitt B, Fillmore J, Arce K. Outcomes of Dental Extractions in the Neutropenic Patient. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Platelet transfusions are a critical component of the supportive care for patients receiving intensive therapy for hematologic malignancies. The platelet count "triggering" prophylactic transfusion has decreased over the years, and studies comparing a prophylactic versus a therapeutic transfusion approach are in progress. The evidence supporting the need for platelet transfusions prior to different invasive procedures is reviewed. Lastly, studies evaluating the use of thrombopoietic stimulating agents to reduce hemorrhage and decrease the need for platelet transfusions are discussed. To date, there is no evidence that this approach is of clinical utility.
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Affiliation(s)
- Jason Valent
- Division of Hematology/Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA.
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12
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Poordad F, Theodore D, Sullivan J, Grotzinger K. Medical resource utilisation and healthcare costs in patients with chronic hepatitis C viral infection and thrombocytopenia. J Med Econ 2011; 14:194-206. [PMID: 21348807 DOI: 10.3111/13696998.2011.562266] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Thrombocytopenia is a significant risk for patients with chronic HCV infection and a common side-effect of treatment with pegylated (PEG) interferon (IFN). Thrombocytopenia predisposes patients to bleeding and requirements for platelet transfusions, and may thus place an increased burden on patients and on medical resource utilisation. SCOPE In a retrospective analysis of an integrated, longitudinal database of medical and pharmacy claims and laboratory results in a US commercial health (insurance) plan, patients with chronic hepatitis C viral (HCV) infection were identified by reviewing ICD-9-CM HCV-, chronic liver disease-, and cirrhosis-related diagnoses. Medical resource utilisation and laboratory results were evaluated during the year following the HCV diagnosis index date as well as during the baseline year prior to that index date. Medical resource utilisation was determined by comparing outpatient visits, emergency department (ER) visits, and inpatient hospital stays for HCV patients with or without thrombocytopenia. FINDINGS HCV patients diagnosed with thrombocytopenia had a greater incidence of bleeding events (27.3 vs. 9.9%), platelet transfusions (8.5 vs. <1%), liver disease-related ambulatory visits (10.4 vs. 4.4; odds ratio [OR] = 2.3; p < 0.001), ER visits (OR = 8.6; p < 0.01), and inpatient hospital stays (OR = 17.7; p < 0.01) during the study period compared with HCV patients without a thrombocytopenia diagnosis. HCV patients with thrombocytopenia had significantly higher overall healthcare costs ($37,924 vs. $12,174; p < 0.001) and liver disease-related costs ($14,569 vs. $4107; p < 0.001) than patients without thrombocytopenia. LIMITATIONS Administrative claims data are subject to coding errors; additionally, the patient population may not be completely representative of the general chronic HCV population. CONCLUSIONS Diagnosis of thrombocytopenia in patients with HCV is associated with increased incidence of certain comorbidities, complications, and medical interventions, and significantly increased medical resource utilisation.
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Affiliation(s)
- Fred Poordad
- Cedars-Sinai Medical Center, Los Angeles, CA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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13
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Koulocheris P, Metzger MC, Kesting MR, Hohlweg-Majert B. Life-threatening complications associated with acute monocytic leukaemia after dental treatment. Aust Dent J 2009; 54:45-8. [DOI: 10.1111/j.1834-7819.2008.01087.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Afdhal N, McHutchison J, Brown R, Jacobson I, Manns M, Poordad F, Weksler B, Esteban R. Thrombocytopenia associated with chronic liver disease. J Hepatol 2008; 48:1000-7. [PMID: 18433919 DOI: 10.1016/j.jhep.2008.03.009] [Citation(s) in RCA: 372] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Thrombocytopenia (platelet count <150,000/microL) is a common complication in patients with chronic liver disease (CLD) that has been observed in up to 76% of patients. Moderate thrombocytopenia (platelet count, 50,000/microL-75,000/microL) occurs in approximately 13% of patients with cirrhosis. Multiple factors can contribute to the development of thrombocytopenia, including splenic platelet sequestration, bone marrow suppression by chronic hepatitis C infection, and antiviral treatment with interferon-based therapy. Reductions in the level or activity of the hematopoietic growth factor thrombopoietin (TPO) may also play a role. Thrombocytopenia can impact routine care of patients with CLD, potentially postponing or interfering with diagnostic and therapeutic procedures including liver biopsy, antiviral therapy, and medically indicated or elective surgery. Therapeutic options to safely and effectively raise platelet levels could have a significant effect on care of these patients. Several promising novel agents that stimulate TPO and increase platelet levels, such as the oral platelet growth factor eltrombopag, are currently in development for the prevention and/or treatment of thrombocytopenia. The ability to increase platelet levels could significantly reduce the need for platelet transfusions and facilitate the use of interferon-based antiviral therapy and other medically indicated treatments in patients with liver disease.
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Affiliation(s)
- Nezam Afdhal
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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15
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Aronovich S, Connolly TW. Pericoronitis as an Initial Manifestation of Acute Lymphoblastic Leukemia: A Case Report. J Oral Maxillofac Surg 2008; 66:804-8. [DOI: 10.1016/j.joms.2006.10.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 10/17/2006] [Accepted: 10/26/2006] [Indexed: 11/29/2022]
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16
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Afdhal NH, Esteban R. Introduction: thrombocytopenia in chronic liver disease -- treatment implications and novel approaches. Aliment Pharmacol Ther 2007; 26 Suppl 1:1-4. [PMID: 17958513 DOI: 10.1111/j.1365-2036.2007.03508.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Thrombocytopenia is a common hematologic toxicity among patients with chronic liver disease. AIM To give a brief overview of thrombocytopenia and its effects on patients with chronic liver disease. RESULTS Thrombocytopenia is generally mild to moderate in severity and can thus be managed relatively easily. Severe thrombocytopenia (platelet count <50,000 /microL), however, may present significant challenges to patient management. Thrombocytopenia can increase the risk of bleeding associated with invasive or surgical procedures. Therefore, while perhaps less widely appreciated than the impact of anemia or neutropenia, effective prevention and management of thrombocytopenia is also critical for patients with liver disease. CONCLUSIONS This supplement to Alimentary Pharmacology & Therapeutics provides a comprehensive review of the significance of thrombocytopenia in patients with chronic liver disease, its pathophysiology and relationship to coagulation disorders, impact on clinical care and resource utilization, and novel therapies that may be able to supplant platelet transfusions.
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Affiliation(s)
- N H Afdhal
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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17
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Abstract
BACKGROUND Thrombocytopenia is a common finding in advanced liver disease. It is predominantly a result of portal hypertension and platelet sequestration in the enlarged spleen, but other mechanisms may contribute. The liver is the site of thrombopoietin (TPO) synthesis, a hormone that leads to proliferation and differentiation of megakaryocytes and platelet formation. Reduced TPO production further reduces measurable serum platelet counts. AIM This paper describes the scope of thrombocytopenia in chronic liver disease and assesses the clinical impact in this patient population. METHODS A medline review of the literature was performed pertaining to thrombocytopenia and advanced liver disease. This data is compiled into a review of the impact of low platelets in liver disease. RESULTS The incidence of thrombocytopenia, its impact on clinical decision making and the use of platelet transfusions are addressed. Emerging novel therapeutics for thrombocytopenia is also discussed. CONCLUSIONS Thrombocytopenia is a common and challenging clinical disorder in patients with chronic liver disease. New therapeutic options are needed to safely increase platelet counts prior to invasive medical procedures as well as to counteract therapies that further exacerbate low platelets, such as interferon. An ideal compound would be orally available and safe, with rapid onset of action.
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Affiliation(s)
- F Poordad
- Cedars-Sinai Medical Center, Center for Liver Disease and Transplantation, Los Angeles, CA 90048, USA.
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18
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Lockhart PB, Loven B, Brennan MT, Fox PC. The evidence base for the efficacy of antibiotic prophylaxis in dental practice. J Am Dent Assoc 2007; 138:458-74; quiz 534-5, 437. [PMID: 17403736 DOI: 10.14219/jada.archive.2007.0198] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION People with various medical conditions and devices are suggested candidates for receiving antibiotic prophylaxis before undergoing dental procedures. This practice is controversial, however, owing to the lack of proof of efficacy. The authors conducted a qualitative, systematic review to determine the level of evidence for this practice and whether antibiotic prophylaxis prevents distant site infections in these patients. METHODS The authors selected eight groups of patients with specific medical conditions and devices who often are given antibiotic prophylaxis before undergoing invasive dental procedures. The conditions and devices were cardiac-native heart valve disease, prosthetic heart valves and pacemakers; hip, knee and shoulder prosthetic joints; renal dialysis shunts; cerebrospinal fluid shunts; vascular grafts; immunosuppression secondary to cancer and cancer chemotherapy; systemic lupus erythematosus; and insulin-dependent (type 1) diabetes mellitus. The authors thoroughly searched the literature for the years 1966 through 2005 for references indicating some level of support for this practice and graded each publication on the basis of level of evidence. RESULTS The authors found formal recommendations in favor of antibiotic prophylaxis for only three of the eight medical conditions: native heart disease, prosthetic heart valves and prosthetic joints. They found no prospective randomized clinical trials and only one clinical study of antibiotic prophylaxis. Only one systematic review and two case series provided weak, if any, support for antibiotic prophylaxis in patients with cardiac conditions. The authors found little or no evidence to support this practice or to demonstrate that it prevents distant site infections for any of these eight groups of patients. CONCLUSIONS No definitive, scientific basis exists for the use of prophylactic antibiotics before dental procedures for these eight groups of patients.
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Affiliation(s)
- Peter B Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC 28232-2861, USA.
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20
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Elad S, Thierer T, Bitan M, Shapira MY, Meyerowitz C. A decision analysis: the dental management of patients prior to hematology cytotoxic therapy or hematopoietic stem cell transplantation. Oral Oncol 2007; 44:37-42. [PMID: 17307024 DOI: 10.1016/j.oraloncology.2006.12.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Revised: 12/05/2006] [Accepted: 12/05/2006] [Indexed: 11/18/2022]
Abstract
There is a controversy regarding whether dental treatment before chemotherapy protocols, including hematopoietic stem cell transplantation (HSCT), is helpful to prevent infections during the consequent immunosuppression. The aim of this study was to develop a decision analysis framework that would test the effect of dental treatment prior to chemotherapy on the survival of the patient. A decision tree was created to compare the clinical outcomes of two treatment alternatives for a base-case patient receiving cytotoxics or undergoing HSCT. The variables used to build the model were "systemic infection", "unmet dental needs", "dental needs". The outcomes evaluate to compare the two strategies was "survival". We performed MEDLINE and PubMed searches of English-language literature according to a list of related terms. The decision analysis model selected dental treatment prior to chemotherapy as the preferred strategy for the base case analysis. The results of this study suggest that dental treatment prior to chemotherapy is the preferred treatment strategy. Using our base case data, 1.8 of every 1000 hemato-oncologic patients or HSCT patients will die compared to the non-treatment prior to chemotherapy strategy.
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Affiliation(s)
- Sharon Elad
- Department of Oral Medicine, The Hebrew University - Hadassah School of Dental Medicine, POB 12272, Jerusalem 91120, Israel.
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21
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Yamagata K, Onizawa K, Yoshida H, Yamagata K, Kojima Y, Koike K, Tsuchida M. Dental management of pediatric patients undergoing hematopoietic stem cell transplant. Pediatr Hematol Oncol 2006; 23:541-8. [PMID: 16928649 DOI: 10.1080/08880010600814187] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study was conducted to evaluate the outcomes of a dental management program the authors designed for pediatric patients receiving hematopoietic stem cell transplant (HSCT) for hematological malignancy. Thirty pediatric patients with hematological malignancies received dental management before HSCT. The outcomes of the dental management and any episode of odontogenic complication were retrospectively evaluated. The pretransplant oral examination showed one or more dental pathologies in 19 children (63.3%), and the remaining 11 patients showed no dental pathologies. Fifteen of the 19 children with dental pathologies received dental treatment, which included restoration, tooth-brushing instruction, scaling, endodontic therapy for permanent teeth, and extraction of primary teeth. No odontogenic infection occurred in any patient during the immunosuppressive period.
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Affiliation(s)
- Kenji Yamagata
- Division of Dentistry and Oral and Maxillofacial Surgery, Mito Saiseikai General Hospital, Ibaraki, Japan.
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22
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Pereira CM, Gasparetto PF, Coracin FL, Marquês JF, Lima CSP, Corrêa MEP. Severe Gingival Bleeding in a Myelodysplastic Patient: Management and Outcome. J Periodontol 2004; 75:483-6. [PMID: 15088888 DOI: 10.1902/jop.2004.75.3.483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The myelodysplastic syndromes (MDS) are a group of stem cell disorders characterized by a reduction in one or more elements of the peripheral blood. Oral manifestations of the disease and oral complications of medical management may result in significant symptoms and have an impact on the systemic condition of the patient. The removal of the infectious focus, such active teeth infection or severe periodontal disease, remains controversial in these patients, due to the increased risk of bleeding and systemic infection. METHODS This paper reports a case of MDS with spontaneous gingival hemorrhage and generalized gingival hyperplasia associated with periodontal disease. This patient underwent several platelet transfusions due to these oral complications. The patient received periodontal therapy, resulting in an improvement of the oral clinical situation and a decrease of gingival hyperplasia. RESULTS The patient did not present any episode of gingival hemorrhage after the periodontal treatment. CONCLUSION The results of this study suggest that periodontal therapy should be performed in MDS patients presenting thrombocytopenia, gingival hyperplasia, and gingival bleeding, with the intent of preventing further hemorrhagic episodes and possible systemic infection.
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Affiliation(s)
- Claudio M Pereira
- Oral Semiology and Oral Pathology, Piracicaba Dental School, State University of Campinas, São Paulo, Brazil.
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23
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Raut A, Huryn JM, Hwang FR, Zlotolow IM. Sequelae and complications related to dental extractions in patients with hematologic malignancies and the impact on medical outcome. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 92:49-55. [PMID: 11458245 DOI: 10.1067/moe.2001.113588] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this retrospective study was to evaluate sequelae and complications after dental extractions and to analyze their impact on medical treatment in patients with myelodysplastic syndrome, acute and chronic leukemia, and multiple myeloma during a 3-year period. STUDY DESIGN The study population included 388 patients with hematologic malignancies. All medical and dental charts were reviewed in a retrospective fashion to identify patients who received dental extractions. Preexisting dental disease and intervention (extraction) were evaluated, and parameters such as days of hospitalization and survival rate were compared with those of the remainder population who did not receive dental extractions. RESULTS Of the 388 patients, 69 underwent dental extractions and 9 had sequelae and complications after the intervention. The resulting complication rate of 13% was reported. Although some patients did experience delay of chemotherapy or bone marrow transplant (BMT), or both, no significant difference was found in the number of days in the hospital for BMT and the survival rate for the patients with sequelae and complications (n = 9) and for the remainder population (n = 319) ( >.05). CONCLUSION Dental extraction intervention provided in the prechemotherapy and pre-BMT time frame did not have a negative bearing on medical outcome.
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Affiliation(s)
- A Raut
- Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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24
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Schiffer CA, Anderson KC, Bennett CL, Bernstein S, Elting LS, Goldsmith M, Goldstein M, Hume H, McCullough JJ, McIntyre RE, Powell BL, Rainey JM, Rowley SD, Rebulla P, Troner MB, Wagnon AH. Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001; 19:1519-38. [PMID: 11230498 DOI: 10.1200/jco.2001.19.5.1519] [Citation(s) in RCA: 453] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine the most effective, evidence-based approach to the use of platelet transfusions in patients with cancer. OUTCOMES Outcomes of interest included prevention of morbidity and mortality from hemorrhage, effects on survival, quality of life, toxicity reduction, and cost-effectiveness. EVIDENCE A complete MedLine search was performed of the past 20 years of the medical literature. Keywords included platelet transfusion, alloimmunization, hemorrhage, threshold and thrombocytopenia. The search was broadened by articles from the bibliographies of selected articles. VALUES Levels of evidence and guideline grades were rated by a standard process. More weight was given to studies that tested a hypothesis directly related to one of the primary outcomes in a randomized design. BENEFITS/HARMS/COST: The possible consequences of different approaches to the use of platelet transfusion were considered in evaluating a preference for one or another technique producing similar outcomes. Cost alone was not a determining factor. RECOMMENDATIONS Appendix A summarizes the recommendations concerning the choice of particular platelet preparations, the use of prophylactic platelet transfusions, indications for transfusion in selected clinical situations, and the diagnosis, prevention, and management of refractoriness to platelet transfusion. VALIDATION Five outside reviewers, the ASCO Health Services Research Committee, and the ASCO Board reviewed this document. SPONSOR American Society of Clinical Oncology
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Affiliation(s)
- C A Schiffer
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit MI, USA
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25
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Patton LL. Hematologic abnormalities among HIV-infected patients: associations of significance for dentistry. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 88:561-7. [PMID: 10556750 DOI: 10.1016/s1079-2104(99)70086-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence and severity of and the factors associated with peripheral blood cytopenias among HIV-infected patients. STUDY DESIGN The investigation involved 516 HIV-infected adults in a longitudinal study of oral disease. Prevalence of hemoglobin, hematocrit, white blood cell, neutrophil, lymphocyte, and platelet values below the lower limit of normal and certain hematologic "critical values" were determined. Demographic, clinical/immunologic/viral stage, medications, and oral lesions were assessed for association with cytopenias by chi(2) and bivariate analyses. RESULTS Findings with respect to prevalence were as follows: anemia, 51%; leukopenia, 43. 4%; neutropenia, 27.5%; lymphopenia, 20.7%; thrombocytopenia, 15.5%. Severe cytopenias were detected in fewer than 1% of the patients. Severity of HIV clinical disease and CD4 cell count depletion were significantly associated with all cytopenias. High viral load was associated only with the leukopenias. Black race, antiparasitic therapy, and some oral lesions were associated with certain cytopenias. CONCLUSIONS In HIV-infected patients, mild cytopenias are common; however, severe anemia, neutropenia, and thrombocytopenia that may predispose to certain oral manifestations and dental surgical complications are rare.
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Affiliation(s)
- L L Patton
- University of North Carolina at Chapel Hill, Department of Dental Ecology, NC 27599-7450, USA
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Affiliation(s)
- M Hejna
- Department of Medicine I, University Hospital, Vienna, Austria
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27
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Salisbury PL, Caloss R, Cruz JM, Powell BL, Cole R, Kohut RI. Mucormycosis of the mandible after dental extractions in a patient with acute myelogenous leukemia. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 83:340-4. [PMID: 9084196 DOI: 10.1016/s1079-2104(97)90240-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Mucormycosis is a fulminant fungal infection that occurs most often in diabetic and immunocompromised patients including those with hematologic malignancies. In this case, a patient with acute myelogenous leukemia developed mucormycosis in a recent mandibular extraction site. The successful management of this patient demonstrated that early diagnosis, aggressive surgical and medical treatment and resolution of the underlying disease could improve the prognosis for survival. A case is made for the role of smoking as an initiator of mucormycosis, and treatment considerations for controlling periodontal and pulpal disease before chemotherapy are discussed.
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Affiliation(s)
- P L Salisbury
- Department of Dentistry, Bowman Gray School of Medicine, Winston-Salem, N.C., USA
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Abstract
The presence of systemic disease in patients requiring periodontal therapy creates challenges for management. Alteration of treatment plans, with emphasis on physician consultation and preventive periodontal care, is frequently needed to minimize the impact of periodontal disease on the systemic condition. Conversely, detection and treatment of systemic disorders may impact upon the status of the periodontium and the success of periodontal therapy. The goal of holistic patient management is facilitated by a free flow of information between the patients and their medical and dental health care providers.
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Affiliation(s)
- B L Mealey
- Department of Periodontology, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA
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Barasch A, Mosier KM, D'Ambrosio JA, Giniger MS, Ascensao J, Peterson DE. Postextraction osteomyelitis in a bone marrow transplant recipient. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:391-6. [PMID: 8469555 DOI: 10.1016/0030-4220(93)90157-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This report describes a case of mandibular osteomyelitis after a dental extraction in a patient who subsequently underwent bone marrow transplantation (BMT) for lymphoblastic lymphoma. Surgical guidelines consistent with National Cancer Institute recommendations were followed for the extraction, which was performed before initiation of the myelosuppressive conditioning regimen. However, moderate tenderness developed at the extraction site beginning 10 days after marrow infusion. On day 26 the patient became febrile and blood culture-positive for Staphylococcus epidermidis. Radiographs exposed on day 28 demonstrated changes consistent with low-grade osteomyelitis, including diffuse loss of lamina dura and an irregular osseous rarefaction extending 1 cm posterior to the extraction site. Although the indwelling Hickman catheter was the presumed source for bacteremia, clinical and radiographic data led to consideration of mandibular osteomyelitis as an alternative cause. Characteristics of this infection in BMT recipients are reviewed. Recommendations for dental extractions and prophylactic antibiotic regimens for catheterized BMT recipients are also discussed. Although mandibular osteomyelitic lesions are not common in profoundly immunosuppressed BMT recipients, prompt recognition and treatment are essential when the disease occurs.
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Affiliation(s)
- A Barasch
- Department of Oral Diagnosis, School of Dental Medicine, University of Connecticut Health Center, Farmington
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