How should adults with cancer be managed by general dental practitioners if they need dental treatment?

Dental infections

  • Dentists should be alert for the possibility of neutropenic sepsis in any patient with a dental infection who is currently receiving chemotherapy, or received chemotherapy in the previous three months, or received total body irradiation in the last six months (e.g. before or after a stem cell/bone marrow transplant) – if suspected, urgently contact the patient’s oncology or haematology team and specialist dental care.
  • For a patient who is currently receiving chemotherapy, or received chemotherapy in the previous three months or total body irradiation in the last six months who does not have neutropenic sepsis, dental infections may be treated in primary care but dentists must get advice from the patient’s oncology or haematology team. Infections should be managed aggressively with close monitoring. Treatment choice often depends on whether the patient is immunosuppressed or at risk of bleeding. Obtain the patient’s blood test results taken within the last 48 hours and check with the patient’s oncology or haematology team whether treatment in primary care is suitable or if special precautions are needed.
  • In all other patients with cancer, treat infections the same as those in patients who do not have cancer, but be extremely vigilant about follow-up and monitoring for deterioration.
  • Before prescribing or using medicines, the dentist should consider the possibility of interactions with the patient’s current cancer treatments.

 

Dental procedures

  • Do not provide emergency dental treatment to a patient currently receiving chemotherapy or radiotherapy to head or neck, or who received chemotherapy or radiotherapy to head or neck in the previous three months, or total body irradiation in the previous six months, before contacting the patient’s oncology or haematology team to find out whether treatment can be carried out safely. If this is not possible, refer the patient urgently to specialist dental care.
  • Do not provide elective invasive dental treatment to a patient currently receiving chemotherapy or radiotherapy to head or neck, or to those who received chemotherapy or radiotherapy to head or neck in the previous three months, or total body irradiation in the last six months, without taking advice from the patient’s oncology or haematology team.
  • Non-invasive dental treatment may be provided in primary care to all patients with cancer, except non-essential work should be avoided during the six months after total body irradiation. If the patient is currently receiving cancer treatment, liaise with the patient’s oncology or haematology team, who is responsible for arranging or carrying out active dental treatment during this time.
  • Invasive dental treatment may be provided in primary care without taking advice from a specialist to patients who:
    • are currently receiving radiotherapy to areas other than head or neck, or
    • received chemotherapy and/or radiotherapy more than three months ago, or
    • are receiving biological or hormonal therapies for their cancer.

However, the dentist should be aware of the possibility of oral adverse effects from cancer treatment, including risk of osteonecrosis (see below). Also, confirm patients with blood cancer are in remission.

 

Osteonecrosis risk

  • Patients who have received intravenous bisphosphonates, denosumab, total body irradiation or radiotherapy to head or neck will be at risk of osteonecrosis of the jaw (in some cases lifelong). Refer to specialist dental care if oral or periodontal surgery is needed or dental infections do not respond to treatment.

 

This Medicines Q&A is currently being updated (due Summer 2019).

CancersOral and dental healthQ&A

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