Abstract
BackgroundOdontogenic diseases can be a risk factor for life-threatening infection in patients with hematologic malignancies during chemotherapy that induces myelosuppression of variable severity. Previous studies noted the necessity of the elimination of all odontogenic foci before hematopoietic stem cell transplantation. To enable planning for the adequate dental intervention, the oral medicine team must understand the general status of patient and the intensity of the chemotherapy, which is sometimes difficult to be fully appreciated by dental staff. Therefore, a simplified grading would facilitate the sharing of information between hematologists, dentists and oral hygienists. This study aimed to introduce our myelosuppression grading of chemotherapies for hematologic malignancies and analyze the timing of occurrence of severe odontogenic infection.Methods37 patients having received various chemotherapies for hematologic malignancies were enrolled. The chemotherapy regimens were classified into four grades based on the persistency of myelosuppression induced by chemotherapy. Mild myelosuppressive chemotherapies were classified as grade A, moderate ones as grade B, severe ones as grade C, and chemotherapies that caused severe myelosuppression and persistent immunodeficiency (known as conditioning regimens for transplant) as grade D. The timing of occurrence of severe odontogenic infection was retrospectively investigated.ResultsTwo patients (5.4%) had severe odontogenic infections after grade B or C chemotherapy. One occurred after extraction of non-salvageable teeth; the other resulted from advanced periodontitis in a tooth that could not be extracted because of thrombocytopenia. Both were de novo hematologic malignancy patients. During grade D chemotherapy, no patients had severe odontogenic infections.ConclusionsThe simplified grading introduced in this study is considered a useful tool for understanding the myelosuppressive state caused by chemotherapy and facilitating communication between medical and dental staff. During the period around the primary chemotherapy, especially for de novo hematologic malignancy patients who often received grade B to C myelosuppression chemotherapy, caution should be exercised for severe odontogenic infection by the oral medicine team, irrespective of whether invasive treatment is to be performed.
Highlights
Odontogenic diseases can be a risk factor for life-threatening infection in patients with hematologic malignancies during chemotherapy that induces myelosuppression of variable severity
Because it is sometimes difficult for dental staff to appreciate fully the myelosuppressive intensity of various chemotherapy regimens, a simplified grading would facilitate the sharing of information between hematologists, dentists and oral hygienists
We attempted to establish at our hospital a system of grading chemotherapy by its myelosuppressive intensity to allow the sharing of appropriate information between medical and dental staff
Summary
Odontogenic diseases can be a risk factor for life-threatening infection in patients with hematologic malignancies during chemotherapy that induces myelosuppression of variable severity. To enable planning for the adequate dental intervention, the oral medicine team must understand the general status of patient and the intensity of the chemotherapy, which is sometimes difficult to be fully appreciated by dental staff. To enable planning for the invasive treatments (e.g. dental extraction and subgingival scaling), the oral medicine team must understand the general status of patient, the intensity of the chemotherapy, and the schedule for future treatment. Because it is sometimes difficult for dental staff to appreciate fully the myelosuppressive intensity of various chemotherapy regimens, a simplified grading would facilitate the sharing of information between hematologists, dentists and oral hygienists. We attempted to establish at our hospital a system of grading chemotherapy by its myelosuppressive intensity to allow the sharing of appropriate information between medical and dental staff
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