Myth or Truth: Is active periodontal care not safe during chemotherapy or radiation?
Drs. Debbie Saunders and Joel Epstein dispel the myth about providing periodontal care for patients undergoing chemotherapy or radiation.
Dr. Debbie Saunders is a Dentist and Medical Director of the Dental Oncology Program, Health Science North, in the North East Cancer Center. She is also Assistant Professor in the Norther Ontario School of Medicine.
Dr. Joel Epstein is Professor and Medical Director Cancer dentistry at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Health System in Los Angeles and the Division of Otolaryngology and Head and Neck Surgery in City of Hope.
There is often confusion about whether patients that are undergoing cancer treatment should continue active periodontal care. There are no contraindications or safety issues concerned with patients having ongoing and routine periodontal care during active chemotherapy. For patients having radiation treatment, it is recommended that dentists consult with the dental specialist at the cancer centre.
Periodontal pathogens that lie in deeper pockets (4mm and more) can cause periodontal abscesses. Often, patients undergoing cancer treatments take medications that can cause mouth sores/mucositis. The mucositis can extend into the periodontal pockets and create open portals for bacteremias.
The timing of periodontal care should be 1 or 2 days prior to or 1 week after the chemotherapy session. This will ensure that the patient’s blood counts are not compromised and that the patient is comfortable. Dentists should educate patients on the importance of continuing periodontal therapy during their cancer treatments and the need to share their chemotherapy and radiation schedules with the practitioner so that timing is optimized. Additionally, practitioners should ask for blood work to ensure that the platelet, total white cells, especially neutrophils and hemoglobin counts are in acceptable ranges to provide treatment without the need for antibiotic prophylaxis or an increased risk of bleeding.
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