- If invasive procedures are planned then current haematological information is
required to assess bleeding risks. - Prophylactic antibiotic therapy to prevent postoperative infection should be
considered. This is given if the functional neutrophil count is depressed. - Children who are immunosuppressed are also at risk of fungal and viral infections.
Fungal infections should be treated aggressively with amphotericin B, nystatin, or
fluconazole, and herpetic infections with topical and/or systemic acyclovir. - Regional block anaesthesia may be contraindicated due to the risk of deep
haemorrhage. - Oral preventive care is important. A typical protocol might include:
While in hospital (paediatric dentistry specialist):
- Relief of mucositis: Difflam mouthwash, topical anaesthesia, antibiotic pastilles,
ice chips. - Elimination of bacterial plaque: chlorhexidine mouthwash 0.12%; povidone
iodine topical application. - Nystatin 500,000 units 'swish and swallow'.
- Topical fluoride therapy.
- Manual plaque removal: toothbrushing instruction if platelet count is greater than
20 × 109 /l; 'foam on a stick' with chlorhexidine if platelet count is less than 20× 109 /l.
At home (primary care provider):
- Oral surveillance.
- Topical fluoride therapy.
- Fissure sealants.
- Diet advice.
- Toothbrushing instruction.
- Prescription of antifungals if required.
Key Points
- Oral side-effects of chemotherapy:
⎯mucositis, oral ulceration;
⎯infection (leucopenia);
⎯haemorrhage (thrombocytopenia). - Oral prophylaxis during chemotherapy:
⎯oral hygiene;
⎯pain relief for mucositis;
⎯fluorides;
⎯chlorhexidine;
⎯antifungals.