Newly diagnosed leukaemia during active chemotherapy

Correct answer: D. Defer definitive prosthodontics; provide a REMOVABLE partial denture only if function demands it, once the mucositis has settled

• A. Any fixed provisional carries the same preparation and bleeding burden as the definitive bridge, without the benefit.
• B. Implants require surgery, healing and osseointegration — all compromised during chemotherapy, with infection risk at the site in a neutropenic patient. Implants are contraindicated until the disease and the counts are stable.
• C. A three-unit bridge means preparing two sound abutments and multiple appointments with gingival retraction and bleeding, in a patient who is thrombocytopenic and immunosuppressed. It sacrifices sound tooth structure for a decision that does not need making now.
• D. CORRECT. NOTHING ELECTIVE happens during active induction chemotherapy. This patient is neutropenic and thrombocytopenic, and the mucosa is already ulcerating. A REMOVABLE prosthesis is the only reasonable option because it requires no surgery, no tooth preparation and no bleeding, and it can be left out while the mucositis is active. Definitive treatment waits until haematological recovery and clearance from the oncologist.

Note: The ideal is dental clearance BEFORE chemotherapy begins: eliminate infection, extract hopeless teeth at least 7–14 days ahead to allow healing, and establish meticulous hygiene. Once treatment has started, care is limited to what is urgent, with counts checked first — generally ANC above 1.0 ×10⁹/L and platelets above 50,000/µL for invasive procedures, and consultation with the oncologist below that.

Correct answer: B. Infection resulting from neutropenia

• A. Adrenal crisis is a risk in patients on long-term corticosteroids or with adrenal insufficiency. Cytotoxic chemotherapy for leukaemia does not itself produce adrenal suppression.
• B. CORRECT. Cytotoxic chemotherapy suppresses the marrow across all lineages. The consequence that dominates dental risk is NEUTROPENIA — an absolute neutrophil count of 0.7 ×10⁹/L means the usual signs of infection are BLUNTED and a minor oral infection can become systemic and life-threatening within hours. Thrombocytopenia adds bleeding risk, and anaemia explains the pallor, but infection is the one that kills.
• C. Hyperglycaemia is a concern with systemic corticosteroids and in diabetes, neither of which is described.
• D. Thyrotoxic crisis follows untreated hyperthyroidism under physiological stress. Nothing in this history points to thyroid disease.

Note: Practical measures for the neutropenic patient: chlorhexidine rinses, aggressive but atraumatic hygiene, treat any oral infection early and definitively, avoid elective surgery, and involve the oncology team in decisions about antibiotic cover. Oral MUCOSITIS is the other predictable problem — it peaks 7–14 days after each cycle, and management is palliative with bland rinses, topical anaesthetics and cryotherapy during infusion.