Table 3.98.
Key considerations for dental management in leukaemia (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 3 | Bleeding tendency; bacterial infections; anaemia; HCV, HBV and HIV infection |
| Appropriate dental care | 3/4 | Stage of disease life expectancy |
| Pain and anxiety control | ||
| – Local anaesthesia | 2 | Avoid regional block; use chlorhexidine rinse |
| – Conscious sedation | 2 | Methotrexate interacts with nitrous oxide |
| – General anaesthesia | 3–5 | Avoid in severe anaemia |
| Patient access and positioning | ||
| – Access to dental office | 1 | Coordinate with oncologist |
| – Timing of treatment | 1 | Coordinate with oncologist |
| – Patient positioning | 0 | |
| Treatment modification | ||
| – Oral surgery | 3–5 | Delay un til remission phase; full blood count; antibiotic cover; do not pack sockets |
| – Implantology | 3–5 | See oral surgery |
| – Conservative/Endodontics | 3/5 | |
| – Fixed prosthetics | 3/5 | |
| – Removable prosthetics | 3 | |
| – Non-surgical periodontology | 3–5 | See oral surgery |
| – Surgical periodontology | 3–5 | See oral surgery |
| – Orthodontics | 3 | Remove bands |
| – Paediatric dentistry | 3 | Remove mobile primary teeth |
| Hazardous and contraindicated drugs | 2 | Avoid aspirin and NSAIDs; some patients receive corticosteroids |
*
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.