Dental prophylaxis for HNC radiotherapy – pro

Severe problems in the mouth can occur after radiation therapy for head and neck cancer. A substantial number  of patientswill suffer clinically significant short and long-term oral adverse effects. Most patients being treated for head and neck cancer (and many patients with other cancers) also experience oral complications from chemotherapy. The most significant risk factors of oral complications of cancer therapy are oral or dental disease that already exists, poor oral care during cancer therapy, and any factor that affects the mouth tissues.

Oral problems that already exist, such as periodontitis, caries, failing restorative work (such as crowns, or fillings), and dentures may increase the risk of infection. Areas where the gums or tissues are irritated can lead to ulceration in the mouth. Pain and discomfort resulting from teeth and gums may make it difficult for a patient to receive all of his or her cancer treatment. Sometimes treatment must be stopped completely. These patients require urgent dental care before and after cancer treatment.

Because of typical tissue reactions to ionising radiation, radiotherapy in the head and neck region usually results in complex oral complications affecting the salivary glands, oral mucosa, bone, masticatory musculature, and dentition. When the oral cavity and salivary glands are exposed to high doses of radiation, clinical consequences including hyposalivation, mucositis, taste loss, trismus, and osteoradionecrosis should be regarded as the most common side-effects. Mucositis and taste loss are reversible consequences, usually subsiding early post-irradiation, whereas hyposalivation is commonly irreversible. Additionally, the risk of rampant tooth decay with its sudden onset and osteonecrosis is a lifelong threat. Thus, early, active participation of the dental profession in the development of preventive and therapeutic strategies, and in the education and rehabilitation of patients is paramount in consideration of quality-of-life issues during and after radiotherapy.

What can a dentist do? It is generally accepted that teetch at risk for other reasons or those teeth exposed to radiation doses of greater than 5000cGy should be extracted. Most treatment protocols to prevent sequelae are still based on clinical experience, but alternatives based on fundamental basic and clinical research are becoming more and more available. The dentist will also generally create fluoride carriers to protect the teeth from decay during radiation.

There are physicans who advocate removal of all metal fillings to allow better penetration of raditaion tehrapy; however, there is littel evidence to support that and radiation distribution can be managed through computer modeling.

Kielbassa AM, Hinkelbein W, Hellwig E, Meyer-Luckel H. Radiation-related damage to dentition.Lancet Oncol. 2006 Apr;7(4):326-35.

J Am Dent Assoc, Vol 129, No 2, 201-205

Vissink A, Burlage FR, Spijkervet FK, Jansma J, Coppes RP. Prevention and treatment of the consequences of head and neck radiotherapy.Crit Rev Oral Biol Med. 2003;14(3):213-25.

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