Review Article

Dental Treatment in Patients with Leukemia

Table 3

Possibility of dental procedures in the prechemotherapy phase.

ProcedureConsiderations and restrictionsTime before the start of CT

Type I
 Exam
  Clinical
  Radiographic
 Hygiene instructions
No restrictions.
 MoldingElective procedure, postpone
Type II
 Simple restorations (ART)
 Prophylaxis and supragingival scaling
No restrictions.
 OrthodonticsElective treatment, postpone.
Consider removing orthodontic appliances.
Type III
 More complex restorationsSolely for adequacy of the oral environment.
Consider use of provisional restorative materials (e.g., glass ionomer).
 Scaling and root planning (subgingival)Invasive procedure of high-risk carried out carefully. To evaluate hematological indices of platelets and neutrophils.
Need for antibiotic prophylaxis.
 Endodontics
  Symptomatic toothEvaluate hematological indices of platelets and neutrophils.
Need for antibiotic prophylaxis.
Consider extraction if endodontics fail.
At least 1 week [1]
  Asymptomatic toothPostpone (tricresol formalin)
OR
Evaluate hematological indices of platelets and neutrophils. Need for antibiotic prophylaxis.
At least 1 week [1]
Type IV
 Simple extractionsInvasive procedure of high-risk.
Evaluate hematological indices of platelets and neutrophils. Need for antibiotic prophylaxis.
3 weeks; minimum 10–14 days [5]
2 weeks; minimum 7–10 days [1]
 Curettage (gingivoplasty)Elective procedure, invasive and high-risk.
Postpone.
Type V
 Multiple extractionsIf for adequacy of the oral environment, evaluate hematological indices of platelets and neutrophils.
Need for antibiotic prophylaxis.
If elective, postpone.
3 weeks; minimum 10–14 days [5]  
2 weeks; minimum 7–10 days [1]
 Flap surgery/gingivectomy
 Extraction of impacted tooth
 Apicoectomy
 Single implant placement
Elective procedure, invasive and high-risk.
Postpone.
Type VI
 Extraction of an entire arch or bothIf adequacy of the oral environment, evaluate hematological indices of platelets and neutrophils.
Need for antibiotic prophylaxis.
If elective, postpone.
3 weeks; minimum 10–14 days [5]  
2 weeks; minimum 7–10 days [1]
 Extraction of multiple impacted teeth
 Flap surgery
 Orthognathic surgery
 Placement of multiple implants
Elective procedure, invasive and high-risk.
Postpone.