Dental Management and Cancer Therapy: Some Important Information to Know Before Undergoing Invasive Procedures

Trained in dental oncology, Lauren Levi, D.M.D., is a general dentist who provides care to cancer patients and is committed to delivering comprehensive oral care. She has extensive experience treating patients who are receiving chemotherapy, radiation therapy, and stem cell transplants and who face individualized dental needs because of these treatment programs.  Dr. Levi will be featuring an oral health series for Meals to Heal this year.

Cancer therapy affects the entire human body, including the oral cavity. Poor oral hygiene and health has been linked to an increased risk of developing oral side effects associated with cancer treatment regimens as well as an increased severity of these conditions. Thus, it is highly recommended that patients visit a dentist with dental oncology training prior to receiving any cancer therapy to help reduce the risk of developing these oral complications.

When should I visit the dentist?

Ideally, the best time to visit a dentist trained in dental oncology is 10 days to two weeks prior to commencing cancer therapy. In the initial visit, the dentist will perform an evaluation and perform any necessary treatment needed prior to receiving cancer therapy. If invasive dental procedures are required, such as extractions, it is ideal to allow 10 days to two weeks of healing time. Nonetheless, it is important to note that it is never too late to visit a dentist while undergoing cancer therapy or after the completion of cancer therapy.

What should my dentist know about my cancer history?

When visiting a dentist, it is important to inform your dentist of any underlying medical conditions as these conditions may affect your dental treatment. For example, it is recommended that people with certain heart conditions or joint surgeries take antibiotics prior to undergoing invasive dental procedures. Additionally, you want to inform your dentist about your cancer history (stage and grade) as well as the proposed therapy and start date. If you will be receiving head and/or neck radiation therapy, you should tell your dentist where the radiation treatment will be delivered. Finally, you should tell your dentist if you have received anti-resorptive medications (bisphosphonate therapy, denosumab, bevacizumab, sunitinib).

What should my oncologist know about my dental history?

Your dentist should inform your oncologist about the presence of any acute dental or periodontal infections as well as the presence of any dental decay (cavities). Furthermore, your dentist should inform your oncologist of any teeth that require extractions as the timing of extractions may affect the your cancer treatment timeline.

If I am undergoing chemotherapy what counts are safe for dental procedures? 

Although a dental oncologist is concerned with all of your blood counts, he/she is most concerned with two counts: your platelet count and your absolute neutrophil count.

Platelets

Platelets are the blood cells required for forming blood clots. The minimum recommended platelet count is 50,000 cells/mm3 for invasive dental procedures such as extractions or other surgical procedures. If dental treatment is absolutely necessary, and your counts are below 50,000 cells/mm3, your dentist may speak with your oncologist and recommend a blood transfusion an hour prior to receiving your dental treatment. If a blood transfusion is recommended, your dentist will most likely, also require post-transfusion blood work to confirm that your platelet count has increased to an acceptable level.

Neutrophils

Neutrophils comprise the greatest number of white blood cells in mammals and are essential for defending the human body against infections. Neutrophils may be measured on a complete blood count report as ‘neutrophil count,’ which is often recorded as a percentage, and ‘absolute neutrophil count.’  The absolute neutrophil count (ANC) is a more reliable measurement than the neutrophil count as it accounts for both the segmented neutrophils (mature neutrophils) and the bands (the immature neutrophils). The minimum ANC recommended for dental treatment without antibiotic prophylaxis is 1.0 k/mm3. In other words, dental treatment should only be performed on patients with an ANC of at least 1.0 k/mm3. If dental treatment is urgent and absolutely necessary, and a patient’s ANC is less than 1.0, antibiotics may be administered prior to dental treatment.

So what’s the bottom line?

Tell your dentist about your ANC count (at least 1.0 K before dental treatment) and platelet (at least 50 K before dental treatment) before undergoing dental treatment.

 

About Dr. Levi

As a general dentist with advanced training in dental oncology, Dr. Lauren Levi delivers comprehensive oral care to cancer patients in a warm, supportive, and gentle environment. After receiving her D.M.D. at the University of Florida College of Dentistry, Dr. Levi completed a general practice residency at New York Presbyterian-Weill Cornell Medical Center. During her residency, Dr. Levi rotated through Memorial Sloan Kettering Cancer Center, where she discovered her interest in dental oncology. She then pursued a fellowship in dental oncology at Memorial Sloan Kettering Cancer Center. This training equipped her with extensive experience performing dental treatment on patients who are receiving chemotherapy, radiation therapy, and stem cell transplants, and those who may face individual dental needs because of these treatment programs. For more information on dental oncology, visit http://laurenlevidmd.com.

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