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).

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.

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).

See Medical Complexity Status for more information.