If you have received high doses of radiation to your face or mouth and need dental surgery, you may be at greater risk of developing a bone healing problem (osteoradionecrosis) after the procedure. Your dentist should discuss this possible complication with a radiation oncologist before any dental surgery. After head and neck irradiation, dental treatment should be approached with caution. Remineralizing gel (Revive) may be useful. Professionally applied topical fluoride and dental prophylaxis should be routine.
Dental restorations with amalgam and glass ionomers are desirable, while composite materials are not recommended. Haveman9 compared amalgam and glass ionomers in xerostomic patients who used topical fluoride gel on a daily basis and in those who did not. Among fluoride users, amalgam and glass ionomers showed no significant difference in the incidence of tooth decay. In non-fluoride users, glass ionomers (materials that release fluorine) reduced the incidence of tooth decay. Wood10 showed that, in patients who used topical sodium fluoride daily, glass ionomer cements failed, while amalgam restorations did not.
In addition, it demonstrated that in patients who did not use topical fluoride, glass ionomer cements did not fail, while amalgam restorations did fail. McComb11 studied glass ionomers and resin-composite restorations in patients with xerostomic head and neck radiation therapy. Composite restorations failed in patients who used fluoride as well as in patients who did not use fluoride. According to these studies, the resin compound is not recommended, while amalgam is recommended for patients who can comply with the use of topical fluorides; the glass ionomer is recommended for patients who may not meet the standards. Radiation therapy can change the amount and consistency of saliva. This increases the risk of tooth decay and gum disease.
Good oral hygiene is important to reduce the risk of these conditions. Your dentist may also recommend special fluoride treatments during and after radiation therapy. This treatment, along with a low-sugar diet, can help protect your teeth. Your doctor or dentist may also recommend exercises to prevent jaw stiffness. Ideally, the patient's oncology or hematology team should be responsible for organizing or carrying out all active dental treatment while the patient is receiving cancer treatment, so you should always contact them before starting a dental procedure during this period.
In the case of patients with tumors that expand rapidly or massive tumors that require immediate radiation therapy, tooth extractions should be postponed and performed within the first 4 months after completing radiation therapy. All dental offices have patients who have undergone, are receiving, or will undergo radiation therapy as part of a comprehensive cancer treatment. For example, Larsen24 advocates the use of Hyperbaric Oxygen (HBO) as a complement to the placement of dental implants, while Keller25 supports the placement of dental implants in jaws radiated without HBO. In addition, dental professionals should be aware of two newer technologies: gamma scalpel technology and intensity-modulated radiation therapy (IMRT) that have implications for oral health. If you have any dental or oral side effects during treatment, report them to your healthcare team right away. Other medications that help control the symptoms and side effects of cancer can also cause dental and oral side effects.
A team including a speech therapist, a dietician, a dental specialist and a psychologist, along with radiation oncology, is required to treat these complications and prevent the morbidity and mortality of patients with head and neck cancer during and after radiation therapy. Backscattering of the radiation beam due to a metallic dental restoration can create localized mucositis, especially on the oral mucosa or on the tongue. Experience seems to show that extractions, periodontal procedures, and even dental implants can be safely performed during this period immediately after irradiation without the use of HBO. When considering the seriousness of these post-treatment ORN complications, it's understandable that aggressive dental treatments such as extractions before radiation therapy are performed. Regular communication with your health care team is important to prevent dental and oral side effects. After standard radiation therapy there is a preformed change in the oral microflora with a decrease in salivary flow which can cause tooth decay.
Dental prophylaxis, professional fluoride application preparation of flexible fluoride trays and detailed home care instructions are all important steps to take. Current topics related to the dental care of patients receiving radiation therapy include the question of bacterial endocarditis (BE) prophylaxis in patients who previously received radiation therapy to the left breast or chest wall; the use of Hyperbaric Oxygen (HBO), amifostine (a sulfhydryl remover) and precautions regarding the daily use of chlorhexidine. It is essential for those undergoing radiation therapy to understand how it can affect their oral health so they can take steps to protect their teeth from decay or other damage caused by radiation exposure. It is important for dentists to be aware of potential complications associated with radiation therapy so they can provide appropriate care for their patients. Dental professionals should also be aware that there are certain treatments that may be beneficial for those undergoing radiation therapy such as Hyperbaric Oxygen (HBO), amifostine (a sulfhydryl remover), professional fluoride application preparation of flexible fluoride trays and detailed home care instructions. In conclusion, it is important for those undergoing radiation therapy to understand how it can affect their oral health so they can take steps to protect their teeth from decay or other damage caused by radiation exposure. It is also important for dentists to be aware of potential complications associated with radiation therapy so they can provide appropriate care for their patients.
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