Akashi Masaya, Kishimoto Megumi, Kusumoto Junya, Yakushijin Kimikazu, Matsuoka Hiroshi, Komori Takahide
Assistant Professor, Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Graduate Fellow, Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Oral Maxillofac Surg. 2018 Oct;76(10):2057-2065. doi: 10.1016/j.joms.2018.05.023. Epub 2018 May 28.
The purpose of this study was to measure the frequency and identify factors associated with delayed socket healing after dental extraction in patients undergoing myelosuppressive chemotherapy for hematologic malignancy.
This prospective cohort study focused on delayed healing after extraction in patients with hematologic malignancy. Sockets with delayed healing were defined as those with intense pain and bone exposure 1 week postoperatively. Patients with and without delayed socket healing were compared using the Fisher exact test and Mann-Whitney U test with some variables. Receiver operating characteristics curve analysis was conducted to define cutoff values for delayed healing.
One hundred ninety-four dental extractions in 93 patients (median age, 64 yr; range, 20 to 85 yr) were analyzed. The incidence of delayed socket healing was 7.5% (7 of 93 patients). There was no postoperative bleeding. Older age, type of hematologic malignancy (acute leukemia), shorter time from dental extraction to initiation of chemotherapy, low platelet count or hemoglobin level, requirement for red blood cell concentrate or platelet transfusion, and use of an absorbable hemostatic agent were statistically associated with the occurrence of delayed socket healing. Platelet and hemoglobin cutoffs were 4.6 × 10/μL and 7.7 g/dL, respectively.
Although dental extraction can be safely performed in patients undergoing myelosuppressive chemotherapy for hematologic malignancy, oral surgeons should understand the potential risk for delayed socket healing. When considering dental extraction, patients with hematologic malignancy and low hemoglobin or platelet levels should be informed about the possibility of delayed socket healing.
本研究旨在测定接受血液系统恶性肿瘤骨髓抑制化疗患者拔牙后牙槽窝愈合延迟的发生率，并确定与之相关的因素。
这项前瞻性队列研究聚焦于血液系统恶性肿瘤患者拔牙后的愈合延迟情况。愈合延迟的牙槽窝定义为术后1周有剧烈疼痛和骨暴露的牙槽窝。采用Fisher精确检验和Mann-Whitney U检验对有或无牙槽窝愈合延迟的患者的一些变量进行比较。进行受试者操作特征曲线分析以确定愈合延迟的临界值。
对93例患者（中位年龄64岁；范围20至85岁）的194颗拔牙进行了分析。牙槽窝愈合延迟的发生率为7.5%（93例患者中的7例）。术后无出血情况。年龄较大、血液系统恶性肿瘤类型（急性白血病）、拔牙至开始化疗的时间较短、血小板计数或血红蛋白水平较低、需要输注红细胞浓缩液或血小板以及使用可吸收止血剂与牙槽窝愈合延迟的发生在统计学上相关。血小板和血红蛋白的临界值分别为4.6×10/μL和7.7 g/dL。
尽管对于接受血液系统恶性肿瘤骨髓抑制化疗的患者可以安全地进行拔牙，但口腔外科医生应了解牙槽窝愈合延迟的潜在风险。在考虑拔牙时，应告知血液系统恶性肿瘤且血红蛋白或血小板水平较低的患者牙槽窝愈合延迟的可能性。
