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

Abstract

This best practice provides recommendations for oral health care for children whose medical therapies result in a lowered immune response. These children have unique oral health needs and are at risk of developing several associated oral and systemic complications. Dentists play an essential role in diagnosing, preventing, stabilizing, and treating oral health problems that can compromise their quality of life before, during, and following immunosuppressive therapies. All children undergoing immunosuppressive or radiation therapy should have an oral examination before such treatment commences. Dental intervention 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 is paramount. Preventive strategies include oral hygiene, diet, fluoride, and education. When completing all dental care prior to therapy is not feasible, priorities should be infections, extractions, periodontal care, and sources of tissue irritation. Recommendations for managing caries lesions, pulp therapy, orthodontia, periodontal conditions, and extractions are included. Elective dental care during immunosuppression is not recommended. Management of oral conditions related to immunosuppressive therapies (e.g., mucositis, xerostomia, trismus) is 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 is completed.

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 radiation therapy.

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