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Letter to the Editor, The oral cavity is a potential infection site in patients undergoing immunosuppressive therapy [1]. These patients are more susceptible to systemic infection, particularly those who need chemotherapy for hematologic malignancies [2]. Many dentists find it difficult to select an approach for dental focal infection in these patients [1, 2]. Although there is some literature assessing oral health in patients undergoing chemotherapy or pre-hematopoietic stem cell transplantation [3], these patients had already experienced adverse effects of chemotherapy, making it difficult to interpret the effect of dental treatment. Tooth extraction is a common surgical procedure performed to eliminate dental focal infection, and it carries a risk of perioperative surgical site infection (SSI) [1]. Although the frequency of tooth extraction-associated SSI is <5% in healthy individuals [4], it may be increased in patients with hematologic malignancy. We retrospectively reviewed the records of 160 patients with hematologic malignancy who visited the Department of Oral and Maxillofacial Surgery, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan, over a 2-year period to clarify the incidence of oral adverse events if dental problems are treated before the first chemotherapy cycle. Seventy-five patients were treated before the first cycle. Dental treatments were performed, and oral health status was assessed after chemotherapy. The observation period was the number of days from the start of the first chemotherapy cycle to just before the start of the second cycle. In cases where the cycle was unclear (e.g., when a single agent was administered repeatedly), the observation period was 30 days from chemotherapy initiation (i.e., the period deemed by hospital management to constitute adequate follow-up). Nine (12.0%) patients experienced oral adverse events after chemotherapy. No significant difference was found between the groups with and without tooth extraction (P = 0.28). The most frequently observed symptom was periodontitis aggravation (n = 3, 33.0%). Although all three patients were deemed to require extraction at the first stomatognathic screening, a decision not to proceed was made in two cases owing to a tight chemotherapy schedule. However, inflammation steadily worsened thereafter. Remarkably, only two of 28 (7.1%) tooth extraction cases had a poor outcome, regardless of the operative stress (surgical or simple extraction). Oral antibiotics (penicillin or cephem) were administered starting just after surgery in all extraction cases and continued at least for 3 days. If oral administration was impossible, the intravenous route was used. The median (min-max) white blood cell * Yasuyuki Shimada yasuyuki.shimada.ys@gmail.com

Importance of eliminating potential dental focal infection before the first cycle of chemotherapy in patients with hematologic malignancy