Chemotherapy and your patient

Chemotherapy drugs are numerous and vastly different in their effects on tumors and normal tissues. From a dental perspective it may not be safe to undertake routine dental care. If there is a sufficient window of opportunity to remove areas of infection and potential areas of infection, undertake a cleaning, scaling and oral hygiene instruction this should be done. The dental examination should be a complete, thorough examination and include a complete radiographic examination. The keystone of treatment is infection removal.

To better prepare yourself for patients requiring chemotherapy treatment ask them to bring a copy of their complete blood count, any coagulation laboratory tests and c complete list of their chemotherapy drugs including the doses and the timing of treatment. You can find information on the many chemotherapy regimens online or in a drug reference text. Patients should also discuss the timing of dental treatment with their oncologist who ideally should give the go-ahead. There are a few critical issues in the management of patients on some chemotherapy regimens that cause immunosuppression.

Be mindful that most patients with central venous catheters may require antibiotic coverage to prevent the catheter from becoming infected.

Always treat the patient in your comfort zone from a hematological standpoint – ie factor in their hemoglobin level, their platelet count, any coagulation disturbances and their absolute neutrophil count. Everyone’s comfort zone is different and it differs from patient to patient and procedure to procedure. Generally during chemotherapy treatment it is better to err on the side of caution. The best way of preventing complications of treatment is to not cause them.

Some chemotherapy agents cause mouth sores. These are best treated symptomatically with various proprietary agents. Consultation with your local pharmacist will prove invaluable in developing the best treatment for these mouth sores.