Oncology
Dental Management of Patients with Active chemotherapy (systemic)
Request recent ANC & platelet count
Active chemotherapy causes myelosuppression. Recent counts are required before invasive care, ideally timed away from the nadir.
Emergency vs routine management
If EMERGENCY — what to do
- • Check FBC on the day: ANC < 1.0 × 10⁹/L or platelets < 50 × 10⁹/L — liaise with oncology; antibiotic cover/platelet support may be needed, preferably in hospital.Ref: Elad S et al. MASCC/ISOO Clinical Practice Guidelines for oral care / mucositis in cancer therapy. Support Care Cancer 2015–2020
- • Fever with neutropenia is a medical emergency — refer to hospital immediately.Ref: Elad S et al. MASCC/ISOO Clinical Practice Guidelines for oral care / mucositis in cancer therapy. Support Care Cancer 2015–2020
- • Treat odontogenic infection promptly as a potential source of sepsis.Ref: Elad S et al. MASCC/ISOO Clinical Practice Guidelines for oral care / mucositis in cancer therapy. Support Care Cancer 2015–2020
If ROUTINE — what to do
- • Schedule invasive care when counts recover (usually just before the next cycle).Ref: Elad S et al. MASCC/ISOO Clinical Practice Guidelines for oral care / mucositis in cancer therapy. Support Care Cancer 2015–2020
- • Oral care protocol: soft brush, bland rinses, high-fluoride toothpaste, mucositis management.Ref: Elad S et al. MASCC/ISOO Clinical Practice Guidelines for oral care / mucositis in cancer therapy. Support Care Cancer 2015–2020
Clinical precautions
- • Obtain FBC (ANC and platelets) before invasive care
- • Time treatment away from the nadir
- • Coordinate with oncology
Information & tests to request
- • Absolute neutrophil count (x10⁹/L)
- • Platelet count (x10⁹/L)
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION Request recent ANC & platelet count |
| Supragingival scaling / polish | MODIFY / CAUTION Request recent ANC & platelet count |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Request recent ANC & platelet count |
| Root canal treatment | MODIFY / CAUTION Request recent ANC & platelet count |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Request recent ANC & platelet count |
| Surgical / bony extraction | MODIFY / CAUTION Request recent ANC & platelet count |
| Implant placement | MODIFY / CAUTION Request recent ANC & platelet count |
References
- Oncology dental management — myelosuppression protocols
- Elad S et al. MASCC/ISOO Clinical Practice Guidelines for oral care / mucositis in cancer therapy. Support Care Cancer 2015–2020
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.