Immune compromise: dental considerations

Patients with immune compromise are at increased risk of infection. The dental management of an immunocompromised patient requires a multidisciplinary approach.

Conditions that can cause profound immune compromise include:

• end-stage kidney disease
• end-stage liver disease
• malignancies
• untreated or end-stage human immunodeficiency virus (HIV) infection
• malnutrition.

Conditions that can be treated with immunosuppressive therapies include:

• autoimmune and inflammatory conditions (eg rheumatoid arthritis, psoriasis, inflammatory bowel disease, systemic lupus erythematosus, vasculitides)
• organ transplantation
• malignancies (see also Chemotherapy: dental considerations).

The degree of immune compromise affects treatment decisions and the use of surgical antibiotic prophylaxis. For example, poorly controlled diabetes can compromise the immune system but is not an indication for surgical antibiotic prophylaxis. Conversely, profoundly immunocompromised patients (eg patients taking high doses of immunosuppressive therapy) may require surgical antibiotic prophylaxis. Consult the patient’s medical practitioner, specialist or multidisciplinary team to determine an appropriate treatment plan and the need for surgical antibiotic prophylaxis.