Oncology Pocket Guide to Oral Health- Part 2

Chemotherapy

The oral complications of chemotherapy depend on the drugs selected, dosages, the degree of dental disease, and use of radiation. Chemoradiation therapy carries a significant risk for mucositis.
Before Chemotherapy

• Refer patients to a dentist for a pretreatment oral health examination, 1 month, if possible, before cancer treatment begins.
• Tell the dentist the treatment plan and timetable.
• Advise the dentist if radiation therapy is also planned.
  
• Allow at least 7 to 10 days of healing from oral surgical procedures before the patient begins myelosuppressive therapy.
  
• Check for immunosuppression or thrombocytopenia before any oral procedures in patients with hematologic cancers.

During Chemotherapy

• Consult with the oral health team to schedule dental treatment.
  
• Conduct blood work 24 hours before any dental procedure. Postpone if
  • platelet count is less than 75,000/mm³, or abnormal clotting factors are present.
  • neutrophil count is less than 1,000/mm³.
• Determine if there is a need for antibiotic prophylaxis before any dental procedures in patients with central venous catheters.
  
• Consult the dentist to explore a possible oral source of infection when fever is of unknown origin.
  
• Ask patients frequently about their oral health.

After Chemotherapy

• Resume a regular dental recall schedule when chemotherapy is completed and all side effects, including immunosuppression, have resolved. 

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