Published: May 2003
Oral/ Dental Evaluation and Treatment Plan
The objective of pre-chemotherapy dental treatment is to eliminate existing infection and to manage potential sources of infection and sites of trauma. The evaluation should include oral hard and soft tissue examination, including periodontal evaluation and necessary radiographs.
Treatment and Maintenance of Teeth
Patients with hematologic malignancies may be immunosuppressed and thrombocytopenic prior to administration of chemotherapy. Dental treatment should be scheduled in consultation with the oncologist.
For all patients, eliminate any area of infection or irritation, such as teeth with fractures, fractured restorations, advanced carious lesions, pulpal or periapical involvement, periodontal inflammation, pericoronitis, or ill-fitting prostheses.
Orthodontic bands should be considered for removal if highly stomatotoxic chemotherapy is expected to be administered. The decision should be made in consultation with the oncologist. Institute periodontal disease control measures that include plaque control, and if possible, a full dental prophylaxis. Patients who continue to maintain excellent oral hygiene throughout therapy may have fewer complications.
Provide oral hygiene instruction, including use of an extra-soft nylon-bristle toothbrush and dental floss, and arrange for ongoing supervision of hygiene during cancer therapy.
Review dietary recommendations to limit highly cariogenic foods without compromising adequate caloric intake.
Additional Needs of Children
Evaluate the dentition and estimate exfoliation time of primary teeth. Remove mobile primary teeth as well as those expected to be lost during the chemotherapy.
Consider removal of gingival opercula if there is a clinical risk for entrapment of food debris and/or nidus for infection, particularly if the area has previously been symptomatic.