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Hematologic Analysis After Gingivectomy
Hematologic analysis after gingivectomy
Irw in W. Scopp,* D D S, and M itchell T . C an to r,f D M D , N ew York
Peripheral blood specimens were taken from ten m en before simple quadrant gingivectomies and 2 and 4 days after the operations. N o significant changes oc curred in leukocyte counts, differential neutrophil counts, erythrocyte sedim enta tion rates, packed cell volum e and hem o globin concentration.
Peripheral blood changes after a simple q u a d ra n t gingivectomy were observed to learn w hether gingivectomy provokes a systemic reaction. Leukocyte, differential neutrophil and lymphocyte counts, ery throcyte sedim entation rate, packed cell volume an d hemoglobin concentration were determ ined. T h e peripheral blood was draw n imm ediately before the gingi vectomy (controls) and 2 an d 4 days postoperatively. B A CK G R O U N D
Blood changes after tooth extraction have been studied by others. Shannon, Davis and Gibson1 reported th a t hem atologic changes occur 4 hours after tooth extrac tion, but not all these changes persist for 2 days and 4 days postoperatively. Four hours after tooth extraction, significant changes were as follows: (1) increase in white blood cells, (2 ), increase in neutro
phils, (3) decrease in lymphocytes, (4) decrease in packed cell volume and (5) increase in corrected sedim entation rate. A fter two days, blood chemistry in dexes returned to norm al except for the corrected sedim entation rate, w hich re m ained elevated through the fourth day. Cheraskin,2 too, found an increase in sedim entation rate four days after tooth extraction. In seven patients, w ho had had an uncom plicated extraction of a lower m olar, a distinct rise in the total leukocyte count in the first and second day and a gradual retu rn to norm al on the third day were observed. T h e relative and absolute num bers of neutrophils re sponded similarly, b u t the percentage of lymphocytes decreased. T h e packed cell volume h ad a slight b u t progressive de cline on the first, second, third and fourth days. I t has been previously established by Shannon and others3’4 th a t dental extrac tions cause stress and are accom panied by increases in the circulatory levels of adrenocortical steroids. M any types of surgery evoke systemic reaction, such as a polym orphonuclear leukocytosis, neutro philic leukocytosis, lym phocytopenia, in creased sedim entation rate and decreased packed cell volume. W e w anted to know w hether the peripheral blood would show these reactions 2 and 4 days after a simple qu ad ran t gingivectomy.
S copp and C a n to r: H E M A T O L O G IC AN A LY S IS 4 1423
T a b le
•
Resulfs o f b lo o d tests b e f o r e a n d a f te r g in g iv e c to m y A f te r g in g iv e c to m y
Test
W h it e b lo o d c o u n t ( W B C / 1 0 0 ml.)
C o n tr o l, b e fo r e g in g i v e c to m y (means)
10,105
C hang e Day 2 Day 2 (means)
9,429
Day 4 (means)
9,442
No.
— 676
Day 4 %
-6 .6
No.
- ■663
%
-6 .5
N e u tr o p h ils
6 4 .2 %
6 7 .1 %
6 2 .5 %
+ 2 .9
+ 4 .5
-1 .7
-2 .7
Lym phocytes
3 0 .0 %
2 8 .9 %
3 0 .1 %
-Î.1
-3
+ 0 .1
+ 0 .3 - 1 7 .3
S e d im e n ta tio n r a te
35.2
33.0
29.1
-2 .2
- 6 .2
-6 .1
P acked c e ll vo lu m e
4 1 .2 %
4 2 .4 %
4 3 .6 %
+ 1.2
+ 2 .8
+ 2 .4
-¡-5.6
H e m o g lo b in (G m ./lO O ml.)
13.1
12.7
13.7
- 0 .4
- 0 .4
-3 .0
+ 4 .5
M ETHOD
Control venous blood samples were col lected from ten hospitalized m en between 9 an d 10 a . m . on the day of operation, just before q u ad ran t gingivectomy. Blood samples w ere again taken 2 and 4 days later a t the same time of the m orning. Five of the patients were hospitalized for tuberculosis, 3 for neuropsychiatric disor ders, 1 for duodenal ulcer an d 1 for em physema. Im m ediately after the blood had been draw n, a simple q u ad ran t gin givectomy was perform ed w ith the p a tient un d er local anesthesia (X ylocaine). A surgical pack (zinc oxide and eugenol base) was applied after the surgical p ro cedure. T h ere was no prescaling, and the patients received no m edication. T h e table presents the results of ro u tine clinical laboratory tests. D IS C U S S IO N
Clinical analysis of the w hite blood cells on the 2- and 4-day specimens showed no significant changes after the q u ad ran t gingivectomy. T h e white blood cell count is a sensitive indicator of systemic reac tions. O n the basis of these data, the peripheral blood seems not to reflect any significant systemic changes after gingi vectomy.
This observation is in contrast to the findings of Shannon, Davis and Gibson1 and Cheraskin2 who reported increased white blood cell count in patients under going an uncom plicated extraction of a m olar. T h e absence of leukocytosis after a gingivectomy indicated th at this p ar ticular operation did n o t seem to evoke body responses, as m easured by the num ber of circulating white blood cells in the peripheral blood. Similarly, the percentage of neutro phils and lymphocytes rem ained constant. Again, significant changes indicate body responses, b u t such changes did not occur. T he erythrocyte sedim entation rate is perhaps the most sensitive index to body chemistry available to the clinician. The m ere extraction of a tooth causes an in crease of sedim entation rate through the fourth postoperative day. T he data in the table show a slight decrease 2 days and 4 days after the gingivectomy. This de crease is not statistically significant and. accordingly, the sedim entation rate did not change as a result of the gingivectomies. Packed cell volume and hemoglobin studies are useful in determ ining w hether a patient is anemic. T h e packed cell vol ume and hemoglobin determ ination taken 2 and 4 days postoperatively remained constant.
1424 • J . A M E R . DENT. AS S N .: V ol. 70, June 1965
C O N C L U S IO N S
Blood studies did not reveal significant systemic changes after simple q u ad ran t gingivectomy. Specimens of the p eriph eral blood were taken from ten hospi talized m en before gingivectomy (control samples) and 2 and 4 days afterw ard. Leukocyte and differential neutrophil counts, erythrocyte sedim entation rate, packed cell volume and hemoglobin con centration were made. T h e findings from this study are in contrast to previous re ports of elevated sedim entation rate four days postoperatively in patients who had had uncom plicated extraction of a molar.
* C h ie f, d e n ta l service, Veterans A d m in is tra tio n H o s p i ta l, First Avenue a t East 24th S treet, New York, and c lin ic a l professor, p e rio d o n tia and o ra l m ed ic in e , New York U n iversity C o lle g e o f Dentistry, New York. fS e n io r resident, p e rio d o n tia , Veterans A d m in is tra tio n H o s p ita l, New York. 1. Shannon, I. L., Davis, E. E., and G ibson , W . A . H e m a to lo g ic changes fo llo w in g s im ple e x o d o n tia . Re p o r t no. SAM-TDR-63-82, N o v. 1963. Brooks A ir Force Base, Texas. 2. Cheraskin, E. D iagno stic s to m a to lo g y . M c G ra w -H ill Book C o ., 1961, p. 34.
New York,
3. Shannon, I. L., and others. Stress p a tte rn s in d e n t a l patie nts. I. Serum fre e 17-hydroxycorticostero ids, sodium and potassium in subjects u n d e rg o in g lo c a l an esthesia and sim p le e x o d o n tic procedures. J. O ra l Surg., A n esth. & H osp. D. Serv. 19:496 N ov. 1961. 4. Shannon, I. L., and others. Stress in d e n ta l patie n ts. II. The serum free 17-hydroxycorticostero id response in ro u tin e ly a p p o in te d p a tie n ts un d e rg o in g sim p le exo d o n tia . O ra l Surg., O ra l M e d . & O ra l Path. 15:1142 Sept. 1962.
Are you going to L as V egas in N ovem ber? Y ou m ay w a n t to see some of th e m ost u n usual rock form ations in the w orld. T h e verm ilion sa n d stone rocks a t th e V alley of F ire, only 35 m iles from L as V egas, are a fav o rite w ith photographers.
Irw in W. Scopp,* D D S, and M itchell T . C an to r,f D M D , N ew York
Peripheral blood specimens were taken from ten m en before simple quadrant gingivectomies and 2 and 4 days after the operations. N o significant changes oc curred in leukocyte counts, differential neutrophil counts, erythrocyte sedim enta tion rates, packed cell volum e and hem o globin concentration.
Peripheral blood changes after a simple q u a d ra n t gingivectomy were observed to learn w hether gingivectomy provokes a systemic reaction. Leukocyte, differential neutrophil and lymphocyte counts, ery throcyte sedim entation rate, packed cell volume an d hemoglobin concentration were determ ined. T h e peripheral blood was draw n imm ediately before the gingi vectomy (controls) and 2 an d 4 days postoperatively. B A CK G R O U N D
Blood changes after tooth extraction have been studied by others. Shannon, Davis and Gibson1 reported th a t hem atologic changes occur 4 hours after tooth extrac tion, but not all these changes persist for 2 days and 4 days postoperatively. Four hours after tooth extraction, significant changes were as follows: (1) increase in white blood cells, (2 ), increase in neutro
phils, (3) decrease in lymphocytes, (4) decrease in packed cell volume and (5) increase in corrected sedim entation rate. A fter two days, blood chemistry in dexes returned to norm al except for the corrected sedim entation rate, w hich re m ained elevated through the fourth day. Cheraskin,2 too, found an increase in sedim entation rate four days after tooth extraction. In seven patients, w ho had had an uncom plicated extraction of a lower m olar, a distinct rise in the total leukocyte count in the first and second day and a gradual retu rn to norm al on the third day were observed. T h e relative and absolute num bers of neutrophils re sponded similarly, b u t the percentage of lymphocytes decreased. T h e packed cell volume h ad a slight b u t progressive de cline on the first, second, third and fourth days. I t has been previously established by Shannon and others3’4 th a t dental extrac tions cause stress and are accom panied by increases in the circulatory levels of adrenocortical steroids. M any types of surgery evoke systemic reaction, such as a polym orphonuclear leukocytosis, neutro philic leukocytosis, lym phocytopenia, in creased sedim entation rate and decreased packed cell volume. W e w anted to know w hether the peripheral blood would show these reactions 2 and 4 days after a simple qu ad ran t gingivectomy.
S copp and C a n to r: H E M A T O L O G IC AN A LY S IS 4 1423
T a b le
•
Resulfs o f b lo o d tests b e f o r e a n d a f te r g in g iv e c to m y A f te r g in g iv e c to m y
Test
W h it e b lo o d c o u n t ( W B C / 1 0 0 ml.)
C o n tr o l, b e fo r e g in g i v e c to m y (means)
10,105
C hang e Day 2 Day 2 (means)
9,429
Day 4 (means)
9,442
No.
— 676
Day 4 %
-6 .6
No.
- ■663
%
-6 .5
N e u tr o p h ils
6 4 .2 %
6 7 .1 %
6 2 .5 %
+ 2 .9
+ 4 .5
-1 .7
-2 .7
Lym phocytes
3 0 .0 %
2 8 .9 %
3 0 .1 %
-Î.1
-3
+ 0 .1
+ 0 .3 - 1 7 .3
S e d im e n ta tio n r a te
35.2
33.0
29.1
-2 .2
- 6 .2
-6 .1
P acked c e ll vo lu m e
4 1 .2 %
4 2 .4 %
4 3 .6 %
+ 1.2
+ 2 .8
+ 2 .4
-¡-5.6
H e m o g lo b in (G m ./lO O ml.)
13.1
12.7
13.7
- 0 .4
- 0 .4
-3 .0
+ 4 .5
M ETHOD
Control venous blood samples were col lected from ten hospitalized m en between 9 an d 10 a . m . on the day of operation, just before q u ad ran t gingivectomy. Blood samples w ere again taken 2 and 4 days later a t the same time of the m orning. Five of the patients were hospitalized for tuberculosis, 3 for neuropsychiatric disor ders, 1 for duodenal ulcer an d 1 for em physema. Im m ediately after the blood had been draw n, a simple q u ad ran t gin givectomy was perform ed w ith the p a tient un d er local anesthesia (X ylocaine). A surgical pack (zinc oxide and eugenol base) was applied after the surgical p ro cedure. T h ere was no prescaling, and the patients received no m edication. T h e table presents the results of ro u tine clinical laboratory tests. D IS C U S S IO N
Clinical analysis of the w hite blood cells on the 2- and 4-day specimens showed no significant changes after the q u ad ran t gingivectomy. T h e white blood cell count is a sensitive indicator of systemic reac tions. O n the basis of these data, the peripheral blood seems not to reflect any significant systemic changes after gingi vectomy.
This observation is in contrast to the findings of Shannon, Davis and Gibson1 and Cheraskin2 who reported increased white blood cell count in patients under going an uncom plicated extraction of a m olar. T h e absence of leukocytosis after a gingivectomy indicated th at this p ar ticular operation did n o t seem to evoke body responses, as m easured by the num ber of circulating white blood cells in the peripheral blood. Similarly, the percentage of neutro phils and lymphocytes rem ained constant. Again, significant changes indicate body responses, b u t such changes did not occur. T he erythrocyte sedim entation rate is perhaps the most sensitive index to body chemistry available to the clinician. The m ere extraction of a tooth causes an in crease of sedim entation rate through the fourth postoperative day. T he data in the table show a slight decrease 2 days and 4 days after the gingivectomy. This de crease is not statistically significant and. accordingly, the sedim entation rate did not change as a result of the gingivectomies. Packed cell volume and hemoglobin studies are useful in determ ining w hether a patient is anemic. T h e packed cell vol ume and hemoglobin determ ination taken 2 and 4 days postoperatively remained constant.
1424 • J . A M E R . DENT. AS S N .: V ol. 70, June 1965
C O N C L U S IO N S
Blood studies did not reveal significant systemic changes after simple q u ad ran t gingivectomy. Specimens of the p eriph eral blood were taken from ten hospi talized m en before gingivectomy (control samples) and 2 and 4 days afterw ard. Leukocyte and differential neutrophil counts, erythrocyte sedim entation rate, packed cell volume and hemoglobin con centration were made. T h e findings from this study are in contrast to previous re ports of elevated sedim entation rate four days postoperatively in patients who had had uncom plicated extraction of a molar.
* C h ie f, d e n ta l service, Veterans A d m in is tra tio n H o s p i ta l, First Avenue a t East 24th S treet, New York, and c lin ic a l professor, p e rio d o n tia and o ra l m ed ic in e , New York U n iversity C o lle g e o f Dentistry, New York. fS e n io r resident, p e rio d o n tia , Veterans A d m in is tra tio n H o s p ita l, New York. 1. Shannon, I. L., Davis, E. E., and G ibson , W . A . H e m a to lo g ic changes fo llo w in g s im ple e x o d o n tia . Re p o r t no. SAM-TDR-63-82, N o v. 1963. Brooks A ir Force Base, Texas. 2. Cheraskin, E. D iagno stic s to m a to lo g y . M c G ra w -H ill Book C o ., 1961, p. 34.
New York,
3. Shannon, I. L., and others. Stress p a tte rn s in d e n t a l patie nts. I. Serum fre e 17-hydroxycorticostero ids, sodium and potassium in subjects u n d e rg o in g lo c a l an esthesia and sim p le e x o d o n tic procedures. J. O ra l Surg., A n esth. & H osp. D. Serv. 19:496 N ov. 1961. 4. Shannon, I. L., and others. Stress in d e n ta l patie n ts. II. The serum free 17-hydroxycorticostero id response in ro u tin e ly a p p o in te d p a tie n ts un d e rg o in g sim p le exo d o n tia . O ra l Surg., O ra l M e d . & O ra l Path. 15:1142 Sept. 1962.
Are you going to L as V egas in N ovem ber? Y ou m ay w a n t to see some of th e m ost u n usual rock form ations in the w orld. T h e verm ilion sa n d stone rocks a t th e V alley of F ire, only 35 m iles from L as V egas, are a fav o rite w ith photographers.