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