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Post Radiation Dental Care

Radiation therapy forms one of the three main pillars of cancer therapy in the head & neck region. It may be used alone as a primary treatment modality or may be used in combination with surgery or chemotherapy.

Tissues receiving radiation therapy undergo certain changes that may influence oral and dental care. These tissue changes may be short-term or long-term.

We will be focusing on the long-term changes and how they influence your dental care.


Mouth Opening:

  • Many patients experience difficulty in opening the mouth wide following radiation therapy

  • It is essential to do physical therapy to allow adequate mouth opening

  • Adequate mouth opening allows for: -

    • Good head and neck oncological exam

    • Good dental exam

    • Oral hygiene maintenance

    • Oral/dental care

  • Oral hygiene carried out regularly is essential for the prevention of dental disease


Cavities / Tooth Decay:

Saliva
  • Saliva is one of the main defence mechanisms of the body against tooth decay

  • The quantity and/or quality of saliva is typically permanently altered following radiation therapy

  • Use saliva stimulating medication or saliva substitutes as advised to maximize protection


Food
  • Avoid cariogenic foods like sugary & sticky foods

  • Make sure to clean your mouth thoroughly after each meal


Fluoride Products
  • Fluoride gets incorporated into tooth minerals and protects against its breakdown

  • To prevent tooth demineralisation/ breakdown fluoride gel application is essential

  • This may require lifelong daily application of either of the formulations:

    • 1.1% neutral sodium fluoride

    • 0.4% stannous fluoride.

  • In case of ongoing demineralisation despite good oral hygiene, remineralising gel or high potency fluoride dentifrice may be used


Dental Visits

Regular dental visits help in:

  • Assessing the level of oral hygiene

  • Detect early breakdown

  • Prevent invasive procedures


Dental Procedures

  • Teeth cleaning / oral prophylaxis:

    • Recommended to get teeth cleaning done to avoid tartar build-up & prevent gum disease

  • Fluoride varnishes:

    • Especially to exposed surfaces of roots to decrease sensitivity & root decay

  • Fillings/ Restorations:

    • Tooth decay must be treated early to prevent progression

    • You may be recommended prophylactic restorations at high-risk sites

    • Anti caries restoration is used that bonds to the tooth & prevent future decay in the same area

  • Root canal treatment

    • Root canal treatment is advised for deeper cavities.

    • Root canal is preferred over tooth extractions

  • Caps/crowns/bridges

    • May be need for extensive decay & tooth loss

    • In case of complicated oral hygiene maintenance

    • Best to avoid tooth decay & tooth loss

  • Tooth extraction

    • Must be avoided as much as possible

    • Irradiated bone at risk of losing vitality & getting exposed

    • Invasive surgical procedure with utmost precaution

    • Extractions may require prolonged antibiotic & hyperbaric oxygen therapy

  • Denture

    • Must be adjusted to avoid sore spots

    • Avoid injury to the radiated bone

    • Decreased saliva may cause difficulty in denture retention



Children

  • Decay: Children may require crowns rather than filling for decay

  • Fluoride: fluoride formulations need to be supervised to avoid dental fluorosis

  • Growth: Jaw growth & tooth development needs to be monitored

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