title: Dental extraction in the neutropenic patient.
abstract: OBJECTIVE
  To identify risks of dental extraction in patients with mild, moderate, and severe neutropenia.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: jonathanfillmore@gmail.com.
authors.forename: W Jonathan
authors.initials: WJ
authors.lastname: Fillmore
authors.affiliation: Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Bryce D
authors.initials: BD
authors.lastname: Leavitt
authors.affiliation: Consultant and Instructor in Surgery, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Kevin
authors.initials: K
authors.lastname: Arce
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D006801:Humans; D007958:Leukocyte Count; D008875:Middle Aged; D009503:Neutropenia / Q000601:surgery*; D014081:Tooth Extraction; D055815:Young Adult