Dental
Prevention
Any patient who has been given high dose RT to the head and neck is likely to be at risk for osteoradionecrosis (a serious bone healing problem) if they have further dental surgery years later.
It is important that the dentist is informed about any previous RT to the jaw and mouth. The dentist should have the opportunity to discuss the risk of osteoradionecrosis with a radiation oncologist before proceeding with the dental surgery. This is a rare complication, but should never be forgotten.
Patients are much more likely to have chronic dental problems. Anyone who has received head and neck RT and/or chemotherapy (especially at a young age) or has chronic oral GVHD requires lifelong dental management aimed at minimizing the risk of dental disease1
Prevention
The following are important to prevent dental decay:
1. Life Style changes:
- Avoid candy!! A diet high in refined carbohydrate predisposes patients to dental decay, especially if their mouth is dry (xerostomic). A diet low in simple sugars is essential2.
- Brushing and flossing teeth regularly helps to prevent periodontitis (gum disease).
- Using topical fluoride gels.
- Antibacterial rinses and sialogogues can be helpful.
2. Visit the dentist/oral oncologist regularly for assessment and monitoring:
Patients need:
- Initial comprehensive dental exam including appropriate radiographs2.
- Crown and root development should be assessed as abnormalities can lead to premature tooth loss2.
- Salivary flow assessment is also helpful in determining the need to fluoride supplementation and or dry mouth products.
- Subsequent follow up
- Frequent dental visits (every 6 months) are recommended to detect early caries, periodontal disease and soft tissue abnormalities2.
Any patient who had RT is at increased risk for the development of a second cancer within the RT field many years later and should have an oral cancer screening examination during his/her visit to the dentist.
Useful resources:
Causes and treatment of xerostomia at the Oral Cancer Foundation
BCCA Nutritional Guidelines For Symptom Management - XEROSTOMIA
Survivorship guidelines for dental health at the Children's Oncology Group
