Why is a dental visit needed before radiotherapy for head and neck cancer?

Hillel D. Ephros, DMD
Oral & Maxillofacial Surgery

Visiting your dentist before receiving radiation for head and neck cancer may prevent some very serious problems that can occur months or years later. The radiation used to treat cancer must be given in high doses to kill cancer cells. As a result, normal tissues around the tumor are also affected. In head and neck cancer, the jawbone and the glands that produce saliva are often damaged by radiation. The result may be a very dry mouth and a jawbone that cannot heal itself. Without the normal cleansing effect of saliva, teeth decay very quickly and dramatically, even in people with good oral hygiene. Should tooth removal be necessary, the jawbone may not be able to heal, resulting in osteoradionecrosis, a very painful and potentially debilitating condition. If you are about to have radiation for mouth cancer or some other tumor in the head and neck region, your dentist should conduct a thorough examination, start an aggressive oral hygiene program and remove all teeth that may put you at risk for osteoradionecrosis. Ideally, this should be done three weeks before radiation begins to allow your mouth to heal. There may be ways to manage dental problems that come up after radiation therapy, but nothing is as safe and predictable as prevention, even if it means the removal of teeth before radiation therapy.  

Of the many possible side effects of radiotherapy (radiation therapy) for head and neck cancer, osteoradionecrosis is one of the most serious. Osteoradionecrosis is the death (necrosis) of bone caused by the disruption of blood vessels due to radiation therapy. It most commonly occurs in the jaw bone after radiation to the head or neck. The necrotic bone cannot be repaired; it requires surgical removal. Osteoradionecrosis is particularly likely to develop if a tooth is removed, so tooth extraction after radiation therapy is avoided if at all possible. Therefore, before beginning radiation therapy for head and neck cancer, individuals should visit their dentist so that any treatable problems can be fixed and all teeth that are considered unfixable can be removed.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.