DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS How can dental professionals optimize their preventive and restorative strategies for patients undergoing head and neck cancer radiotherapy?
As patients undergoing head and neck cancer radiotherapy grapple with a plethora of dental complications, this article dives into the practical nuances of their dental management. Leveraging a multidisciplinary approach, it explores key preventive and restorative strategies, offering vital insights into managing this vulnerable patient population.
Key Points:
- Dental complications in head and neck cancer radiotherapy patients include mucositis, trismus, xerostomia, radiation caries, and osteoradionecrosis.
- A two- to three-week waiting period for mucosal healing post-extraction is acceptable before radiotherapy commencement, as complete dentoalveolar bone remodeling may take several months and occur during radiotherapy.
- Meticulous oral hygiene is critical in managing xerostomia and mucositis, both of which increase the risk of oral infections.
- Early physical therapy is key to managing trismus, a complication resulting from the fibrosis of mastication muscles.
- Pre-treatment dental assessment and management help minimize dental emergencies during radiotherapy.
- One-in-three patients develop caries within two years of radiotherapy, with the incidence related to the radiotherapy dose.
- Regular oral hygiene and daily topical fluoride use are crucial preventive measures against radiation caries.
- Restorative management in irradiated patients presents challenges like trismus and xerostomia, with no current material meeting the ideal standards of being caries-resistant, durable, adherent, aesthetic, and easy to use.
- Endodontic treatment for pulpally involved teeth is generally preferred over extraction, even for teeth with poor restorative prognosis.
Additional Points:
- Crowns and bridges are generally avoided in xerostomic patients due to increased caries risk, and removable prostheses can limit plaque control and traumatise tissues.
- Implants placed in irradiated bone are more than twice as likely to fail as those in non-irradiated bone.
- Osteoradionecrosis (ORN) associated with extractions has a 5-15% incidence rate, while ORN associated with implant placement has a 3% incidence rate.
Conclusion:
Dental management of patients undergoing head and neck cancer radiotherapy necessitates a comprehensive, multidisciplinary approach that emphasizes preventive care, restorative treatment decisions based on individual patient needs, and ongoing research to refine practices.
Radiation Oncology Further Reading
- Incompetent Leaders, Overworked Nurses Compromised Cancer Patients at Mission Hospital, Oncologist Testifies
- Why Going Gray Might Be Your Body’s Way of Fighting Cancer
- Definitive and Postoperative Radiation Therapy for Basal and Squamous Cell Cancers of the Skin
“Comprehensive pre-treatment assessment and management of incipient dental conditions should minimise dental emergencies during radiotherapy. Radiotherapy interruptions should be avoided, as delays reduce treatment efficacy and thus survival.”
British Dental Journal
