Friday, February 7, 2014

Oncology Pocket Guide to Oral Health

Patients receiving radiation therapy to the head and neck are at risk for developing oral complications. Because of the risk of osteonecrosis in irradiated fields, the best time to perform oral surgery is before radiation treatment begins. Prior to treatment, the dentist will consider extracting all teeth that may pose a problem in the future.

Before Head and Neck Radiation Therapy
  • Refer the patient to a dentist for a pretreatment oral health examination, ideally 1 month before cancer treatment begins.
  • Tell the dentist the treatment plan and timetable. Be sure the dentist is knowledgeable about cancer care issues.
  • Help prevent tooth demineralization and radiation cavities by making sure the patient has a good oral hygiene program and has received instruction on fluoride gel application.
  • Allow at least 14 days of healing for any oral surgical procedures before radiation treatment.
  • Make sure pre-prosthetic surgery is done before treatment begins—surgical procedures may be contraindicated on irradiated bone.
During Radiation Therapy
  • Make sure the patient follows the recommended oral hygiene regimen, whether at home or in the hospital.
  • Monitor mucosa and oral structures for bleeding and infection.
  • Advise patients not to wear removable appliances during treatment.
After Radiation Therapy
  • Consult with the dental team about dentures and other appliances after mucositis subsides. Patients with friable tissues and xerostomia may not be able to wear them again.
  • Make sure that the patient follows up with a dentist for fluoride gel/home care compliance. Lifelong, daily applications of fluoride gel are needed for patients who are severely xerostomic.
  • Monitor the patient for trismus. Check for pain or weakness in masticating muscles in the radiation field. Instruct the patient to exercise jaw muscles three times a day, opening and closing the mouth as far as possible without pain; repeat 20 times.
  • Advise against oral surgery on irradiated bone because of the risk of osteonecrosis. Tooth extraction, if unavoidable, should be conservative; use antibiotic coverage and possibly hyperbaric oxygen therapy.
  • Consult the dentist to monitor irradiated craniofacial and dental structures for abnormal growth and development in pediatric patients.
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