Dental Management of Pediatric Patients Receiving Immunosuppressive Therapy and/or Head and Neck Radiation

Abstract

This best practice provides recommendations for oral health care for children undergoing immunosuppressive therapy and/or head and neck radiation. These children have unique oral health needs and are at risk of developing multiple associated oral and systemic complications. Dentists play an essential role in diagnosing, preventing, stabilizing, and treating oral health problems that can compromise a patient’s quality of life before, during, and following such therapies. All children undergoing immunosuppressive therapy and/or head and neck radiation should have an oral examination before such treatments commences. Dental interventions must be performed promptly, efficiently, and with attention to the patient’s unique circumstances and treatment protocol. Preventing new dental problems and treating existing dental conditions before immunosuppressive therapy and/or head and neck radiation is paramount. Preventive strategies include oral hygiene, diet, fluoride, and patient education. When completing all dental care prior to therapy is not feasible, priorities should be treatment of odontogenic and periodontal infections, extractions, periodontal care, and removal of sources of tissue irritation. Recommendations for management of caries lesions, pulp therapy, orthodontia, periodontal conditions, and extractions are included. Strategies to manage oral conditions related to immunosuppressive therapies and head and neck radiation are addressed. For children undergoing hematopoietic cell transplantation, all dental treatment should be completed before the patient becomes immunosuppressed and elective care postponed until immunological recovery has occurred.

This document was developed through a collaborative effort of the American Academy of Pediatric Dentistry Councils on Clinical Affairs and Scientific Affairs to offer updated information and guidance regarding dental management of pediatric patients receiving immunosuppressive therapy and/or head and neck radiation.

KEYWORDS:  IMMUNOSUPPRESSION, DENTAL CARE, RADIATION THERAPY, MUCOSITIS, TREATMENT PROTOCOL, PHOTOBIOMODULATION