Wisdom teeth removal and cancer treatment?

Dear Kim,

I have a son that has been diagnosed with cancer and is expected to start treatment soon - probably chemotherapy. He has impacted wisdom teeth that may need to be removed. Should the wisdom teeth be removed before or after the cancer treatment?

Question:

Dear Karen,

This is a challenging situation. I am not an oral surgeon or an oncologist.

If this were a patient that I was treating, I would definitely consult with both of the above-identified specialists immediately. The type of cancer, method and duration of treatment, and the condition of the wisdom teeth are just a few important details that should be addressed by his doctors.

If chemotherapy is the chosen treatment, it will weaken his immune system which may effect his recovery from having his wisdom teeth (third molars) extracted. In any patient with a compromised immune system, increased risk of infection is always a concern. Generally speaking, cancer treatment should take priority since cancer may be life threatening and impacted wisdom teeth are a relatively less serious condition compared with cancer.

Unfortunately, dentists often focus on tooth-associated complications when justifying or questioning an extraction. This is a perfect example of why the potential medical complications of the patient must be addressed. One study I found entitled "Prophylactic extraction of third molars in cancer patients", recommended preventative extraction of partially erupted or impacted wisdom teeth in cancer patients before the cancer therapy is started based on the following observations: 1) the increased risk associated with post-cancer-treatment extraction; 2) the management of third molars may interfere with the patients cancer treatment; and 3) the potential for third molars to produce complications in immunocompromised patients before, during and immediately after their anticancer treatment.

Another study that examined the postoperative recovery of 146 patients after their wisdom teeth were extracted found that (with regard to pain level): 1) males noted more pain on the first and third days after extraction than females; 2) patients treated by more experienced oral surgeons experienced less pain compared to patients treated by inexperienced surgeons; 3) a direct correlation existed between pain level and patient age. While this study did not specifically address cancer patients, it provides some general factors to consider when wisdom teeth may be extracted.

My advice to you, Karen, is to be sure your cancer specialist and oral surgeon (and/or family dentist) are communicating effectively with you and between themselves. This will enable them to coordinate the best total treatment plan for your son. Take an active, positive role in this process.

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