Dental Extractions Guidelines for Patients Receiving Chemotherapy With Myelosuppression

 

Timing:

(1) The extraction should be done at least 10 days prior to the time when the patient's absolute neutrophil count will be < 500 per µL. Typically this means that the extraction must be performed no less than 3-4 days before the start of the chemotherapy regimen.

(2) If there is insufficient time to perform the extraction prior to the period of myelosuppression, then pulpal therapy can be used to control the acute infection, with the extraction deferred until after marrow recovery has occurred.

 

Performing the extraction:

(1) Use the minimal surgical trauma possible.

(2) Use alveolectomies as needed to achieve primary closure.

(3) Multiple interrupted sutures are used for primary closure.

(4) Avoid hemostatic packing material.

 

Problem	Prophylactic Therapy
platelet count < 40,000 per µL at the time of the extraction	Administer platelets 30 minutes prior to the extraction.
absolute granulocyte count < 2,000 per µL	Administer broad spectrum antibiotics 30 minutes prior to surgery and 6 hours post-operatively.

 

where:

• The type of platelets to administer depends on the availability. Irradiated leukopoor single donor products may be beneficial.