Oral health care considerations for patients before starting radiation therapy (XRT):
- For patients who are to receive XRT, any oral care should be coordinated with the medical team treating the patient.
- If the patient is to receive XRT, the dentist may be asked to eliminate oral sources of infection and nonrestorable teeth.
- Aggressive oral rehabilitation is recommended. Any tooth that may need to be extracted in the future, all root tips, and all teeth with periapical pathology should be extracted.
- Aggressive short-term periodontal therapy and hygiene prophylaxis should be instituted. Impressions for fluoride trays should be made.
- Any surgical procedure should be completed at least 2-3 weeks before XRT.
- To minimize future complications, adequate healing of surgical sites should be achieved before instituting XRT.
- Preoperative casts and registrations should be prepared for patients undergoing jaw resections.
Dental treatment for patients while receiving radiation therapy (XRT):
- Only perform emergency dental care.
- Avoid extractions during this period, as the risk for developing osteoradionecrosis is high. If possible, wait until after cessation of XRT to perform extractions.
- Institute frequent dental prophylaxis.
- Use fluoride mouthrinses/trays.
- Institute prophylactic antimicrobial mouthrinses to prevent opportunistic infections.
- Institute analgesic/mucosal protective mouthrinses to alleviate introral pain and discomfort.
- Address oral complications (see below).
Dental treatment for patients after radiation therapy (XRT):
- Institute daily fluoride therapy with custom trays. Use neutral pH fluoride.
- Institute salivary substitutes or sialogogues to induce salivation.
- Delay construction and insertion of full and partial dentures for 3-12 months after cessation of XRT.
- Do not perform any surgical procedures without consulting the patient’s radiation oncologist. The risk for developing osteoradionecrosis develops after XRT dosages of 4,000 cGy are accumulated.
- Address oral complications.
- Radiation-induced heart disease may be caused by XRT to the chest area and could require antibiotic bacterial endocarditis prophylaxis before dental care.
Oral complications associated with radiation therapy (XRT):
- Mucositis – Inflammation and ulcerations of mucous membranes. Mucositis increases the risk for systemic infections and is often associated with pain and discomfort.
- Xerostomia – Reduction or absence of saliva predisposes the patient to caries, oral candidiasis, dysphagia, and problems with chewing and speech.
- Infections – Opportunistic bacterial, viral, and fungal infections may develop due to leukopenia, xerostomia, and mucositis.
- Trismus – Loss of elasticity and fibrosis of masticatory muscles may occur when muscles are in the direct line of high XRT dosage.
- Periodontal disease – When the periodontium is in the direct line of high XRT dosage, attachment and subsequent tooth loss may ensue.
- Caries – Rampant caries and increased incidence of root caries may develop with diminished salivary flow.