Table 1.
Oral pre-HSCT conditions, classification of risk of local and systemic complications due to previous dental conditions and Dental Treatment recommendation.
| Dental Condition |
Specific Condition |
Classification for local or systemic complication related to previous oral condition | Treatment recommendation |
Recommendations for dental management |
|---|---|---|---|---|
| Chronic Periodontal Disease: PSR(Periodontal Screening & Recording) | 0 – (WHO periodontal color band): during probing the color band still visible at the gingival sulcus . No calculus or defective margin . Healthy gingival tissue with no bleeding at probing |
Low | Oral Hygiene Instructions (OHI) | No special recommendations *In the absence of the WHO periodontal prob it must be used another method that allows periodontal examination following the same principles presented in PSR index. |
| 1 - Color band still completely visible at the sextant deeper gingival sulcus . No calculus or defective margin with restoration . Bleeding at probing |
Low | OHI + Prophylaxis Removal of the bacterial plaque (including subgingival plaque) |
No special recommendations | |
| 2 - Color band still completely visible at the sextant deeper gingival sulcus . Supra- or subgingival calculus and/or . Defective margin with restoration |
Low | Root surface debridement (Removal of granulation tissue and supra- and subgingival calculus) . Removal of retentive areas . Ideal time of 1 week for transplantation |
In case of subgingival scraping and/or potential gingival lesion: . Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| 3 - Color band partially visible Pockets 3.5 – 5.5 mm |
Moderate | . Complete Periodontal Exam . OHI + Root surface debridement . Ideal time of 2 weeks for transplantation, at least 1 week * |
. Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| 4 – Color band completely invisible Pockets: > 5.5 mm – consider 6.0 mm |
High | . OHI + Root surface debridement . Complex treatment or difficulty of periodontal decontamination – indicate extraction at pre-transplantation . Ideal time of 2 weeks for transplantation, at least 1 week* |
. Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| Acute Periodontal Disease |
Periodontal abscess Symptoms like pain and sings like tenderness of the gingiva, swelling, presence of an ovoid elevation in the gingiva along the lateral part of the root, suppuration on probing, deep periodontal pocket (7.3–9.3 mm), bleeding on probing, and increased tooth mobility. Bone loss was normally observed in the radiographic examination. |
High | . This condition must be solved before transplantation. Subgingival irritant factor removal and antibiotic therapy. . Tooth extraction if the mobility was greater or equal than grade III and/or periodontal pocket was deeper than 6mm. . Ideal time of 2 weeks for transplantation, at least 1 week* |
. Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
Necrotizing periodontal disease .Intraoral findings are necrosis and ulcer in the interdental papilla, gingival bleeding, pain, pseudomembrane formation, and halitosis. Extraoral signs included adenopathy and/or fever. |
High | . Debridement and antibiotic therapy before the transplantation. . Periodontal status must be observed for therapeutic decision . Ideal time of 2 weeks for transplantation, at least 1 week* |
. Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
|
Endo-Perio . Presence of a periodontal pocket reaching or close to the apex combined with absence of pulp vitality. |
High | . Tooth extraction . Ideal time of 2 weeks for transplantation, at least 1 week |
. Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| Dental caries |
Caries with no pulp involvement Shallow cavity with no risk of pulp exposure during restorative treatment and with no symptomatology |
Low | . Definite restorative treatment whenever possible . Atraumatic restorative treatment if there is no time for definite treatment . Follow-up |
No special recommendations |
|
Caries with pulp involvement, and appropriate tooth structure Consider irreversible pulpitis and deep caries at risk of exposure during treatment |
High | . If there is enough time for HSCT: endodontic treatment and restoration or extraction. . If there is not enough time: consider provisional curative treatment or extraction . Follow-up |
In case of extraction: . Check blood count . Discuss the need for prophylaxis/ATB therapy |
|
|
Caries with pulp involvement, no appropriate tooth structure |
High | . Tooth extraction - If there is not enough time or no clinical condition for extraction -endodontic curative treatment - follow-up |
In case of extraction: . Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| Dental conditions that present risk for mucosal trauma | High for local complication | . Temporary or definite resolution of the condition depending on available time | . In case of bloody procedure: . check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| Third molar |
Asymptomatic partially erupted tooth |
Low | . Periodontal assessment (see periodontal criteria) . Careful hygiene of the pericoronal hood. |
In case of bloody procedure: . Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
Symptomatic partially erupted tooth |
High | . Periodontal assessment (see periodontal criteria) .If there is time for healing (14 days): .Orpeculotomy or extraction . If there is no time for healing: local cleaning using chlorhexidine 0.12% + discuss antibiotic therapy * |
In case of bloody procedure: . Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| Impacted tooth with no radiographic lesion | Low | . Maintenance/ observation |
. No recommendations | |
| Endodontic Problem | Incomplete endodontic treatment with no symptoms or radiographic signs | Low | . Follow-up | . No recommendations |
| Acute periapical infection (periapical abscess) | High | . Consider the possibilities of periapical infection control: extraction or endodontic treatment |
. Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| Chronic periapical change (radiographic lesion with no symptoms during percussion) | Low | . Tooth with endodontic treatment: - clinical follow-up . Tooth with no endodontic treatment - depending on sufficient time until HSCT and on the possibility of resolution of the periapical picture: endodontic treatment; intracanal medication therapy, extraction *Important to exclude other changes that may simulate periapical lesion |
. In case of extraction: . Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| Residual roots | Asymptomatic roots and no periapical lesion | Low | -Extraction*, or clinical follow-up if there is no sufficient time until HSCT. | . Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
| Roots with percussion symptoms and/or with periapical lesion | High | -Extraction | . Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| Orthodontic appliance | High (oral mucositis) | . Mandatory removal The maintenance of fixed retainers, away from the oral mucosa and in patients with good hygiene can be discussed |
. No recommendations | |
| Dental pediatrics |
Teeth in physiological exfoliation |
High (If thrombocytopenia otherwise moderate risk) |
-Deciduous teeth with more than 2/3 of reabsorbed root and grade 3 mobility must be extracted . If there is enough time: extraction . If there is not enough time: follow-up |
. Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
| Deciduous teeth with endodontic treatment and symptomatic, or with mobility, or with radiographic lesions | High | - Extraction .If there is not enough time: treatment with local care and use of antibiotic therapy |
. Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| Deciduous teeth with pulpar and/or periapical involvement | High | -Extraction . If there is not enough time: treatment with local care and use of antibiotic therapy |
. Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| Permanent teeth with incomplete eruption and gingival hood, no symptoms | Low | . If there is enough time: Orpeculotomy . If there is not enough time: Optimization of oral hygiene and local cleaning using chlorhexidine |
-In case of Orpeculotomy: . Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
| Permanent teeth with incomplete eruption and gingival hood, with inflammatory/infectious symptoms | High | . Orpeculotomy | . Check blood count (platelet count) . Check coagulogram if necessary . Discuss the need for prophylaxis/ATB therapy |
|
x
For mouth preparation, resolution of infectious foci must be prioritized. The indication of surgical procedure out of the ideal time for healing must be discussed according to each case.
⁎⁎ All surgical manipulations must consider the potential risks of bone necrosis of the maxillaries due to previous exposure to radiation therapy or induction drugs.