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Radiation Therapy (XRT) - Oral Health Care Considerations

  • 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, an oral health care professional may be asked to eliminate oral sources of infection and non-restorable 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#

  • 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#

  • Institute daily fluoride therapy with custom trays. Use neutral pH fluoride.
  • Institute salivary substitutes or sialagogues 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 prophylaxis before dental care.

Oral complications associated with radiation therapy#

  • 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.
  • For more detailed information (see Sroussi HY, et al. below).

Medical Complexity Status - Radiation Therapy#

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See Medical Complexity Status for more information.

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