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The Effects of Odontogenic Infection on the Complete Blood Count in Children and Adolescents

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The Effects of Odontogenic Infection on the Complete Blood Count in Children and Adolescents PEDIATRIC DENTISTRY/Copyright @1984by The American Academyof Pediatric Dentistry Volume 6 Number 4 The effects of odontogenic infection on the complete blood count in children and adolescents Randy T. Travis, DMDClifford J. Steinle, DDS Abstract whomsepsis is suspected. The latter study also dem- Hospital charts of children 2-18 years were reviewed onstrated that an elevation of the neutrophil count retrospectively and categorized by one of the following without a concurrent increase in the band neutrophil diagnoses:(1) dental (:aries, (2) dental caries count may occur in patients in whomthere is no evi- periradicularpathoses, (3) facial cellulitis of dental origin, dence of infection. 5 Weitzman, in a review of the or (4) periorbital cellulitis (nondental etiology). The medical literature concerning the diagnostic utility of values for each patient were tabulated in an attempt to the WBCcount and differential count, cites many establish a characteristic blood responsepattern for the generally known and accepted conclusions dealing various stages of dental infection. Results showedthat a with the effects of infectious and noninfectious enti- measurable blood response is uncommonuntil the ties6 on the WBCcount and the differential count. infection progressesto the stage of acute cellulitis. The WBCcount and differential count are not the However,at that stage, a characteristic pattern of blood response is seen for such infections. only components of the CBCto be affected by infec- tious processes. Anemiais a commonfeature of chronic infections and occasionally may complicate acute in- In the past, the CBChas been chiefly a tool of the fection; this usually indicates a hemolytic infection. physician. Standard normal values for the various CBC Clostridial bacteremia may produce massive intra- components have been available for nearly 40 years, vascular destruction of erythrocytes by producing a and in the last two decades clinicians have become lecithinase and hemolysins which act on the mem- branes of red cells and cause their destruction. Ane- adept at utilizing CBCresults for making diagnostic, prognostic, and therapeutic recommendations.17 Thus mia is common in cases of subacute bacterial far, use of the CBCby dentists has been limited; most endocarditis, tuberculosis, brucellosis, and chronic CBCexaminations are ordered as part of a battery of pulmonary infections such as lung abcesses and em- routine laboratory examinations upon admission to pyema. The anemia of chronic infections usually is the hospital for operative dentistry and oral surgery. normocytic and normochromic but may be normo- However, some CBCexaminations are requested for cytic and hypochromic. The platelet count is a valu- treatment of patients with facial cellulitis of dental able test in that isolated thrombocytopenia may develop during the course of some acute gram-pos- origin to monitor the course of the infection and the 7 efficacy of therapy. The various indices of the CBC itive and gram-negative bacterial infections. long have been known as sensitive indicators of the As of this writing, no scientific studies examining physiologic3 and pathologic state of the individual. the hematologic effects of odontogenic infection as manifested in the routine CBCcould be found in the White blood cell count and the differential white blood medical or dental literature. It is the purpose of this cell counts have been used for the past 75 years to help evaluate infectious and noninfectious diseases. study to examine the effects of odontogenic infection Manroe et al. demonstrated that a carefully done upon various CBCparameters, and to define a char- differential white blood cell count maybe of signifi- acteristic hematologic pattern for such infections. cant help in distinguishing early-onset streptococcal Methods and Materials disease from other causes of respiratory distress in neonates. 4 Zipursky et al. concluded that an elevation Hospital charts of patients 2-18 years were re- of the band neutrophil count above the normal range viewed and selected in the following manner. A ret- is a valuable prognostic sign in premature infants in rospective search was conducted screening for one of 214 EFFECT OF ODONTOGFNIC INFFCTION ON CBC: Travis and Steinle TABLE1. Cumulative Summaryof Meanand Standard Deviation Values for CBCand Body Temperature Data Control Range Groupla Grouplb Group2 Group3 ~ 4.83 ~ 4.60 ~ 4.72 ~ 4.58 RBC/mm3 4.32 - 5.12 ~ 0.51 ~ 0.40 ~ 0.55 ~ 0.37 ~ 38.4 ~ 38.0 ~ 37.6 ~ 36.77 Hct % 34.5 - 40.9 ~ 3.5 g 3.2 ~ 5.3 ~ 3.0 ~ 12.9 ~ 12.84 ~ 12.9 ~ 12.4 Hgb mg/100 cc 11.7 - 14.1 ~ 1.2 ~ 7.1 ~ 1.3 ~ 1.1 ~ 81.1 ~ 82.5 ~ 80.9 ~ 80.7 MCV3 u 76 - 84 ~ 13.4 ~ 15.0 ~ 4.9 ~ 4.6 ~ 29.3 ~ 28.9 ~ 27.39 ~ 27.6 MCH pg 24.4 - 28.5 ~ 5.4 ~ 8.5 ~ 2.0 ~ 4.2 ~ 33.6 ~ 33.8 ~ 33.7 ~ 33.8 MCHCgm/100 ml 32.1 - 36.1 ~ 0.9 g 0.8 g 1.47 ~ 0.9 ~ 337,500 ~ 394,250 Platelets/mm3 135,000- 466,480 no data no data ~ 62,077 ~ 59,225 ~ 7,200 ~ 7,100 ~ 12,400 ~ 15,000 Total3 WBC/mm 4,500 - 11,000 ~ 2,200 ~ 2,100 ~ 3,600 ~ 6,200 56.0 P 34.0 L 73.8 P 18.8 L 70.6 P 19.1 L Differential WBC 4.0 M2.7 E no data no data 5.8 M.9 E 5.4 M1.1 E .5B 3.0 Bands .1 B .8 Bands .1 B 3.3 Bands Body temp. (°F) 98° ~ 98.5 ~ 98.6 ~ 100.2 ~ 100.2 (acceptable range ~ 0.8 ~ 0.7 ~ 1.40 ~ 1.7 97° _o) 99 Age ~ 6.9 yrs ~ 6.4 yrs ~ 6.1 yrs ~ 8.4 yrs ~ 5.9 yrs Sample size control population N = 35 N = 36 N = 40 N = 42 three final diagnoses: (1) dental caries, (2) facial was: Group la, N=33; Group lb, N=36; Group 2, lulitis secondary to dental origin, and (3) periorbital N = 40; and Group 3, N = 42. cellulitis (dental etiology having been ruled out). Group Leukocyte count (WBCcount), erythrocyte count 1 was divided into two subgroups. Group la was (RBC count), hematocrit, hemoglobin concentration, designated "multiple caries without, periradicular pa- mean corpuscular volume, mean corpuscular hemo- thosis." Group lb was designated "multiple caries globin, and mean corpuscular hemoglobin concentra- with periradicular pathoses." The subclassification was tion were analyzed by automated instrumentation in based upon a thorough review of each patient’s den- the hospital hematology laboratory. The WBCdiffer- tal chart. Multiple caries were confirmed through ex- ential count and the platelet count were completed amination of full mouth radiographs and/or clinical manually by conventional smear techniques and read charting. Periradicular pathosis likewise was con- by certified technicians. firmed through examination of dental radiographs andY The CBCutilized for each patient was that obtained or specific mention of single or multiple fistulas or upon admission to the hospital. Values for body tem- parulis of dental etiology. In Groups 2 and 3, the use perature also were obtained upon admission. All val- of the term "cellulitis" to describe each patient’s con- ues for body temperature were adjusted to an dition upon admission to the hospital was consistent equivalent oral temperature if taken rectally or in the 8 with the definition given by Schuster and Burnett. axillary areas. 1° Control values for each of the com- The search was terminated when the number of pro- ponent analyses comprising the CBCwere standard spective cases in each of the four groups was 60 (N normal values for the population served by the Cin- = 6O). cinnati Childrens’s Hospital Medical Center (CHMC). In each group, the patient’s medical history was These values were obtained previously and apart from reviewed. Any case with a suspected or positive his- this study by the (CHMC)hematology laboratory for tory of hematologic disease or abnormality was ex- purposes of establishing normal CBCvalues. Veni- cluded from the study. Also excluded were patients puncture and capillary bed blood samples were drawn receiving antibiotic therapy and those patients re- from 100 patients 2-10 years (6.3 years mean age) ceiving any pharmacologic agent with known he- undergoing outpatient surgery who presented in good matologic effects. 9 Final population size for each group health with no apparent illness or infection as certi- PEDIATRICDENTISTRY: December 1984Nol, 6 No, 4 215 TAi~LE2. Absolute C.ounts for Individual LeukocyteSpecies Range %Greater % Less Than Cells/mm3 ~ cells/mm 3 g cells/mm 3 Than MaximumLimit MinimumLimit n Control (A) PMNs 2,520 - 6,160 (B) Lymphocytes 1,530 - 3,740 Control (C) Monocytes 180 - 440 population for CHMC (D) Eosinophils 122 - 297 (E)Basophils 22 - 55 (F)Band forms 135 - 330 Group 2 (A) PMNs 4,386 - 17,548 9,574 3,422 85.O% 0.0% 40 (B) Lymphocytes 596 - 6,096 2,433 1,164 10.0% 20.0% (C) Monocytes 176 - 1,782 746 397 80.0% 2.5% (D) Eosinophils 0 - 700 110 147 7.1% 65.0% (E) Basophils 0 - 162 17 42 12.5% 87.5% (F) BandNeutrophils 0 - 712 99 195 15.8% 82.5% Group 3 (A) PMNs 2,400 - 23,331 10,595 5,065 83.3% 2.4% (B) Lymphocytes 708 - 7,261 2,859 1,420 19.0% 7.1% (C) Monocytes 0 - 4,480 860 822 74.8% 9.5% (D) Eosinophils 0 - 1,370 169 288 16.7% 59.5% (E) Basophils 0 - 360 15 44 11.9% 88.1% (F) Band Neutrophils 0 - 4,256 501 1,052 28.6% 66.7% fled by preoperative history and physical by an ex- hospital and must be completed manually by certified amining physician. technicians.) This policy and the fact that the data in Blood samples in Groups 2 and 3 were obtained by this study was gathered in retrospect accounts for the venipuncture.
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