Oral Complications of Chemotherapy and Head/Neck Radiation

Table 2. Management Guidelines Relative to Invasive Dental Procedures

Medical Status Guideline Comments

Patients with chronic indwelling venous access lines (e.g., Hickman). AHA prophylactic antibiotic recommendations (low risk). There is no clear scientific proof detailing infectious risk for these lines following dental procedures. This recommendation is empiric.

Neutrophils Order CBC with differential.

>2,000/mm³ No prophylactic antibiotics.

1,000–2,000/mm³ AHA prophylactic antibiotic recommendations (low risk). Clinical judgment is critical. If infection is present or unclear, more aggressive antibiotic therapy may be indicated.

<1,000/mm³ Amikacin 150 mg/m² 1 hour before surgery; ticarcillin 75 mg/kg IV ½ hour before surgery. Repeat both 6 hours postoperatively. If organisms are known or suspected, appropriate adjustments should be made based on sensitivities.

Platelets^a Order platelet count and coagulation tests.

>75,000/mm³ No additional support needed.

40,000–75,000/mm³ Platelet transfusions are optional; consider administering preoperatively and 24 hours later. Additional transfusions are based on clinical course. Utilize techniques to promote establishing and maintaining control of bleeding (i.e., sutures, pressure packs, minimize trauma).

<40,000/mm³ Platelets should be transfused 1 hour before procedure, immediately obtain platelet count, transfuse regularly to maintain counts above 30,000–40,000/mm³ until initial healing has occurred. In addition to above, consider using hemostatic agents (i.e., microfibrillar collagen, topical thrombin). Monitor sites carefully.

CBC = complete blood cell count; IV = intravenous.

^aAssumes that all other coagulation parameters are within normal limits and that platelet counts will be maintained at or above the specified level until initial stabilization/healing has occurred.