Review Article

Dental Treatment in Patients with Leukemia

Table 4

Possibility of dental procedures in transchemotherapy phase.

ProcedureConsiderations or restrictionsTime between cycles

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.
Consider removing orthodontic appliances.
Type III
 More complex restorationsSolely for adequacy of the oral environment.
Consider use of provisional restorative materials (eg., Glass ionomer).
 Scaling and root planning (subgingival)Invasive treatment, of high-risk, perform carefully. 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 fails.
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 treatment 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 treatment, invasive and high-risk. Postpone.
Type V
 Multiple extractionsIf 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.