Prosthodontics & Occlusion · patient case question
What is the most appropriate management of the edentulous span at this time?
Patient case: Newly diagnosed leukaemia during active chemotherapy
Patient: Female, 46 years old
Chief Complaint: “I want to replace the teeth I lost on the lower right.”
Background: Acute myeloid leukaemia diagnosed six weeks ago. Currently mid-cycle on induction chemotherapy. No other medical history.
Vital Signs: BP 112/70 mmHg · HR 96 bpm · T 99.4°F · WBC 1.6 ×10⁹/L · absolute neutrophil count 0.7 ×10⁹/L · platelets 68,000/µL
Findings: Teeth 28, 29 and 30 missing. Remaining dentition sound with healthy periodontium. Generalized mucosal pallor with scattered areas of mucositis. No acute infection.
Show answer and explanation
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.
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