State of the evidence base for medically necessary oral health care

A decision analysis: the dental management of patients prior to hematology cytotoxic therapy or hematopoietic stem cell transplantation

There is a controversy regarding whether dental treatment before chemotherapy protocols, including hematopoietic stem cell transplantation (HSCT), is helpful to prevent infections during the consequent immunosuppression. The aim of this study was to develop a decision analysis framework that would test the effect of dental treatment prior to chemotherapy on the survival of the patient. A decision tree was created to compare the clinical outcomes of two treatment alternatives for a base-case patient receiving cytotoxics or undergoing HSCT. The variables used to build the model were "systemic infection", "unmet dental needs", "dental needs". The outcomes evaluate to compare the two strategies was "survival". We performed MEDLINE and PubMed searches of English-language literature according to a list of related terms. The decision analysis model selected dental treatment prior to chemotherapy as the preferred strategy for the base case analysis. The results of this study suggest that dental treatment prior to chemotherapy is the preferred treatment strategy. Using our base case data, 1.8 of every 1000 hemato-oncologic patients or HSCT patients will die compared to the non-treatment prior to chemotherapy strategy.