The Importance of Pre Radiation Dental Evaluations

When the treatment for cancer of the head and neck requires radiation therapy, a thorough dental examination before treatment begins, by a dentist trained in this area, can help patients avoid many complications and achieve optimal results. To understand why it is imperative to have a pre radiation evaluation, it is first necessary to understand how radiation affects the oral cavity, salivary glands, teeth and bone.

Because it is very difficult to exclude the salivary glands from the radiation fields in the head and neck, radiation therapy may affect the salivary glands and the result is a change in the quantity and quality of the saliva. Saliva is important when discussing oral health because it both lubricates the mouth and balances the mouth’s acidity, thereby preventing tooth decay. Many patients experience dry mouth, called xerostomia.

Another more serious effect of radiation is to decrease the size and number of blood vessels in the area of radiation. This causes a decrease in the ability of irradiated tissue and bone to heal following surgery, injury or infection. Post radiation infections can be very serious with prolonged healing times, occasionally resulting in osteoradionecrosis.

For this reason, it is very important to thoroughly evaluate a patient’s dentition prior to radiation. To avoid future complications after radiation of the head and neck, any questionable teeth within the field of radiation may need to be extracted prior to initiation of radiotherapy. Extraction of teeth following radiotherapy could place the patient at risk for infections and osteoradionecrosis. In addition, during the pre radiation evaluation, custom topical fluoride trays are fabricated. These trays allow application of topical fluoride daily to help decrease the incidence of dental caries and infection. Patients should also be aware of the need for meticulous oral hygiene, as remaining teeth are usually at risk for dental caries secondary to their xerostomia, or lack of saliva. Long term maintenance includes three month visits to the family dentist or periodontist for cleaning and checkups. This is a lifelong commitment that patients need to make for optimal oral health.

In summary, the goal of the pre radiation dental evaluation is to avoid or minimize post radiation complications. By precluding many complications that could jeopardize treatment options and slow recovery, a thorough pre radiation dental examination is very important.