Head and neck radiotherapy: dental considerations

Patients who require head and neck radiotherapy should be reviewed by a dentist experienced in cancer management, as part of a multidisciplinary team. Radiotherapy can cause oral pain, mucositis, reduced salivary flow, oral infection, trismus and altered taste. Reduced salivary flow can increase the risk of periodontal disease and dental caries. Good oral hygiene can reduce the incidence, severity and duration of adverse effects associated with radiotherapy. Ensure optimal oral health; if possible, any necessary dental treatment should be completed before starting radiotherapy. If extractions are performed, allow adequate time for wound healing (usually 10 days to 3 weeks) before starting radiotherapy, if possible.

Patients who have had head and neck radiotherapy are at increased risk of osteoradionecrosis. Encourage regular dental review and seek advice from the patient’s multidisciplinary team before performing tooth extractions that are within the field of radiotherapy. If possible, choose conservative dental treatment options (eg periodontal treatment, restorations, endodontic treatment [root canal], fluoride application). Neutral fluoride products are better tolerated than acidulated products. Management of osteoradionecrosis is difficult and requires specialist management.

For more information on the dental management of patients undergoing head and neck radiotherapy, see the eviQ website.