Head and Neck Radiation Therapy
Management of Irradiated Patients
The management of dental patients who have undergone head and neck radiation therapy is challenging. Radiation kills cancer cells because they replicate more frequently, however normal cells are damaged or killed as well. Over time, the irradiated tissue bed becomes more hypoxic (less oxygenated) and exhibits hypocellularity (less viable cellular elements) and hypovascularity (poorer blood supply). These changes worsen over time. Thus, the patient who received head and neck radiation 5 years ago as part of their cancer treatment is less able to heal a wound within the radiated field than a patient who just completed radiation therapy 1 month ago. The center of the radiation field is where the greatest tissue damage occurs.
Patients should be seen by their dentist before radiation therapy ideally. The dentist should carry out caries control and prophylaxis. Any patient with teeth planned for removal should be referred to the oral surgeon as soon as possible. To help protect the remaining teeth, impressions should be made for fluoride trays.
Even sound teeth in the direct path of radiation at or exceeding 6,000 cGy should be seriously considered for extraction. Teeth with periodontal disease and those that are heavily restored are also vulnerable. Strong consideration should also be given to removal of tori, bony exostoses, tuberosity reduction, and smoothing of sharp lingual bony ledges in the mylohyoid region. Maxillary teeth can often be kept, unless they are otherwise planned for extraction, because the superior maxillary blood supply helps to protect against osteoradionecrosis. All extractions and preprosthetic surgery should be done 3 weeks prior to initiation of head and neck radiation therapy. This will allow for adequate healing time and minimize the risk of osteoradionecrosis.
The most common complications from head and neck radiation therapy are:
- Radiation Mucositis
- Radiation Caries
- Radiation-Induced Xerostomia
- Radiation Dysphagia
- Radiation-Induced Trismus