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Oral and Dental Management Before Cancer Therapy

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    Oral Disease Stabilization Before Chemotherapy and/or Hematopoietic Stem Cell Transplantation

    • Data provided by oncology team to dental providers:
      • Underlying disease:
      • Type of transplant:
        • Autologous.
        • Allogeneic donor types:
          • Matched related and unrelated.
          • Mismatched related.
        • Mismatched unrelated.
        • Syngeneic.
      • Hematopoietic stem cell source:
        • Bone marrow.
        • Peripheral stem cells.
        • Cord blood stem cells.
      • Conditioning regimen:
        • Myeloablative.
        • Reduced-intensity conditioning (including nonmyeloablative regimens).
      • Planned date of transplant.
      • Conditioning regimen:
        • Chemotherapy.
        • Total-body irradiation.
        • Radioactive antibodies.
      • Current hematologic status and immunologic status.
      • Present medications.
      • Other medical considerations:
        • Cardiac disease (including murmurs).
        • Pulmonary disease.
        • Indwelling venous access line.
        • Coagulation status.
        • Splenectomy.
    • Data provided by dental providers to oncology team:
      • Dental caries (number of teeth and severity, including designation of number of teeth that should be treated before cancer treatment begins).
      • Endodontic disease:
        • Teeth with pulpal infection.
        • Teeth with periapical infection.
      • Periodontal disease status.
      • Number of teeth requiring extraction.
      • Other urgent care required.
      • Time necessary to complete stabilization of oral disease.

    The overall goal is to complete a comprehensive oral care plan that eliminates or stabilizes oral disease that could otherwise produce complications during or following chemotherapy. Achieving this goal will most likely reduce risk of oral toxicities with resultant reduced risk for systemic sequelae, reduced cost of patient care, and enhanced quality of life. If the patient is unable to receive the medically necessary oral care in the community, the oncology team should assume responsibility for oral management.

    It is important to realize that dental treatment plans need to be realistic relative to type and extent of dental disease and how long it could be before resumption of routine dental care. For example, teeth with minor caries may not need restoration before cancer treatment begins, especially if more conservative disease stabilization strategies can be used (e.g., aggressive topical fluoride protocols, temporary restorations, or dental sealants).

    Specific interventions are directed to:

    • Mucosal lesions.
    • Dental caries and endodontic disease.
    • Periodontal disease.
    • Ill-fitting dentures.
    • Orthodontic appliances.
    • Temporomandibular dysfunction.
    • Salivary abnormalities.

    Guidelines for dental extractions, endodontic management, and related interventions (see Table 3) can be used as appropriate.[6,7] Antibiotic prophylaxis prior to invasive oral procedures may be warranted in the context of central venous catheters; the current American Heart Association (AHA) protocol for infective endocarditis and oral procedures is frequently used for these patients.

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