Dentistry during Chemotherapy

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  • Dentistry during Chemotherapy
  • I have just created an account to ask the question on the Macillan website, but the reply from a dentist may take up to two days and I am conscious that Christmas is nearly upon us so I am looking for any real world experiences.

    A relative is undergoing very targeted Chemotherapy and has just been diagnosed with a cracked tooth. The dentist is refusing treatment because of chemo will “have ruined the immune system” and they have recommended contacting the hospital dentist.

    The Chemo is so targeted that I don’t think the immune system is affected so it should not prevent dental treatment, but I understand the dentists caution.

    Anyone have any experience of this and able to give advice/pointers?

    Cheers

    Premier Icon brant
    Subscriber

    I have paged someone.

    Premier Icon scaredypants
    Subscriber

    talk to the centre that delivered the chemo – everyone else is just guessing

    talk to the centre that delivered the chemo

    Not so easy as the care was recently transferred and I don’t have much of a list of names/contacts at the moment. That said I could go back to the original contacts in London…

    submarined
    Member

    I know very little about this, but I do know that some drugs that are not actual Chemo but given at the same time can cause issues. My wife had to have a series of pamidronate(frequently used for bone cancers) infusions, and was instructed that before she started, she needed to have any major dental work done that may need doing within the next 2 years. She had to have a wisdom tooth removed. IIRC the drug increased the risk of necrosis of the jaw which, could be increased even further by having any dental work.

    Premier Icon paul4stones
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    I’m a dentist but it’s difficult to comment specifically as I’m sure you’ll understand.
    Generally chemotherapy will affect the immune system and I’m not aware of anything that will be targeted in a way that won’t have some systemic effect. I’m no expert on chemotherapy though. The effect of that is to make infections more of a problem and also the risk of infection after surgery, such as removing a tooth, is much greater including the risk of necrosis of the bone described above.
    A lot depends on what the actual dental problem is. A cracked tooth could just give some sensitivity until a bit breaks off and the resulting hole can be repaired. None of that would be affected by chemo. The danger is if the crack causes the nerve in the tooth to die off and become infected. In that situation the infection is likely to be more serious and, it’s likely the tooth would need to be extracted with the risks mentioned above.
    As already said though you really need some advice from the people in charge. They will usually have links to dental people too and will probably be able to coordinate any dental treatment needed. I’m sorry if that creates some logistical problems but realistically that’s what’s needed.
    Good luck.

    Thanks everyone. Sage advice!

    TiRed
    Member

    What drugs? Chemotherapy as in cytotoxic drugs will lower many blood parameters including platelets and white blood cells. Targeted kinase inhibitors such as Braf and Mek may not (although some still do). I’d look at the US prescribing information first.

    Most people undergoing chemotherapy will have a named nurse and a point of contact, I think? So that’s a way in to the system. If in doubt, ring up the ward where she was getting chemo.

    What drugs? Chemotherapy as in cytotoxic drugs will lower many blood parameters including platelets and white blood cells

    It’s “Imatinib” which is ‘cytotoxic’ (Google tells me this is a drug which works by inhibiting the growth of abnormal cells), but the blood counts do not seem to have been an issue/important for the past 4-5 years.

    If in doubt, ring up the ward where she was getting chemo.

    It’s a prescribed drug that has been taken for the best part of five years. There is no ward involved.

    That said I could go back to the original contacts in London…

    Do this. I can’t see that they wouldn’t be able to offer advice and further contacts. Could be a bit of hunting around on your part, on the Saturday before Christmas.

    You may need to dig up the current team because you’ll need the most recent blood results as evidence of immune status. This may be on the GP record if the surgery is open first thing.

    Premier Icon dms01
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    If the tooth has fractured and can be repaired with a filling -unlikely to be a problem

    Root canal treatment should be possible, may be with a lower threshold for prescription of some prophylactic antibiotics.

    Extraction if required, still possible – and if needed sooner better, but will carry the potential for increased risk of complications.

    General rule of thumb, stabilise the problem by the least invasive means.

    Yes I’m a dentist, and a tier 2 surgery provider (half way between general practice and hospital). Ideally sight of current blood tests, and a chat with oncology would be best prior to an extraction.

    TiRed
    Member

    15% thrombocytopenia in the larger trials and bleeding side effects. Has a black box warning. The recommendation is dose reduction to manage toxicity. Your friend needs to go back to his care givers for more advice

    Imatinib is a targeted therapy but it’s a big well expressed target unlike some of the others.

    Speak to the folks at the prescribing centre. They’ll have the patient’s history, regimen, and a fair understanding from experience of what the risks are.

    Ah, imatinib aka GLEEVEC®. For leukemia? Go and see a dentist who can read the prescribing instructions, take a medical history, and offer an informed choice to the patient. Since both leukaemia and GLEEVEC® have some adverse effects on things that can complicate surgery (infections for example) it needs some thought.

    Good luck and happy holidays.

    Buy a digital thermometer.

    I had to check my Mother hourly and once the temp was up I had to take her to hospital for antibiotics or antivirals.

    An infection can kill a chemo patient.

    Wait till the patient recovers from a previous dose and a week before the next one if they are desperate.

    You can ring your local Macmillan nurse who can ask the oncologist if they don’t know. It’s the only charity we donate to.

    Thanks for the continued interest/views/advice.

    The Macmillan dental specialist has not responded yet and I can’t get hold of any ‘key workers’

    Luckily the discomfort is not too bad so the urgency is not yet there (hopefully this will continue until after the Christmas break when things become easier)

    NB It’s not lukemia but a GIST and the ‘chemo’ is a daily does ‘forever’ not a phased approach so there are no downtime’s for the body to recover when dental surgery would be easier

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