Radiation Treatment for Cancer and Dentistry

When a patient is going to start a series of radiation treatments, especially to the head and neck, a potential dental problem may arise. The cells and the blood supply are compromised. When this area does not heal from the treatment, a condition known as osteoradionecrosis has occurred. According to Wikipedia, this condition is chronically painful and there are surface ulcers accompanying this. It is more likely to occur in the mandible (lower jaw).

 Solution: Drastic

The solution for this condition seems very drastic. The oncologist frequently recommends that a patient has all of their teeth removed prior to starting radiation treatment. The major problem is when a compromised tooth develops a problem requiring extraction, the bone won’t heal and the patient will be much worse off. Also, after radiation, the patient is prone to osteonecrosis for the remainder of their life.

Guidelines for Extractions

Guidelines are published from the University of Florida School of Dentistry for assessing whether or not to perform extractions before treatment, and if so, how extensive. Non-dental factors include the radiation dose, location of ports, patient prognosis, patient compliance with caring for their teeth, and finances. The dental factors include gum disease, decay, the size and condition of fillings and root canals. The further the patient is from ideal the more the dentist will recommend to the oncologist to extract teeth.

 The Goal

As a dentist, this is a solution that seems excessive. But, cancer is a life threatening disease and the goal is to give the patient the best chance of surviving with a quality life. So, this solution will minimize later complications in the jaw.