British Dental Journal (BDJ)The Dental Management of Patients Irradiated for Head and Neck Cancer

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.

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