Medical Emergencies · patient case question
Which complication of her therapy is of greatest concern during dental treatment?
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: 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.
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