Dental management prior to hematopoietic stem cell transplantation

The authors investigated oral health treatment in patients scheduled for hematopoietic stem cell transplantation. Fifteen patients were scheduled for bone marrow transplantation: 12 had leukemia, two had aplastic anemia, and one had myelodysplastic syndrome. Twenty-three patients were scheduled to undergo peripheral blood stem cell transplantation: 20 had malignant lymphoma and three had leukemia. Patients with platelet counts of < or = 50,000/mm3 who required tooth extraction and those with platelet counts of < or = 30,000 /mm3 who required scaling received platelet transfusions before the dental treatment. We saw no bleeding problems in these patients. Dental care for patients who had neutrophil counts of > or = 500/mm3 included tooth extractions or scaling, with no postoperative infection. Even those with severe immunosuppression (neutrophil count: 100-150/mm3) tolerated treatment when prophylactic measures, such as intravenous administration of antibiotics, were used. One patient with a neutrophil count of < or = 50/mm3 developed an infection after even conservative therapy. Thus, caution should be exercised when treating patients scheduled for HSCT as even conservative therapy can initiate and infection.