An update on the effects of radiation therapy and dental management of head and neck cancer patients

Abstract

Defects in the maxillofacial region may result in cosmetic, functional and psychological impairment which can have far reaching effects on patients’ quality of life. Head and neck cancer may be treated with a variety of modalities including surgical resection, chemotherapy and radiation therapy. Ionising radiation destroys tumour cells, rendering them less able to divide, and thereby halting tumour progression, but also destroys many normal cells leaving patients with a number of oral and/or facial side effects, some of which develop quickly and others only becoming evident after some time. This paper will review these complications and the effects they have on patient functionally, aesthetically and psychosocially. It will also propose ways in which dentists can be part of the multidisciplinary team who try to prevent, reduce or manage post radiation sequalae, and help restore patients’ dignity, functioning and general quality of life. The topic of osseointegrated implants in irradiated bone is a much debated, complex and controversial issue. This will be addressed in a follow-up review.

Treatment Complications of Head and Neck Cancers and Rehabilitation Measures: A Narrative Review

“…Radiotherapy: The optimal delivery target, radiation type, and dose are crucial factors when considering a patient for dental rehabilitation. Ionizing radiation damages blood vessels in bone and adjacent tissues, leading to irreversible bone damage, tissue hypoxia, and a significant risk of osteoradionecrosis (ORN) following trauma or infection [23]. The risk of developing ORN is higher when performing surgery or dental procedures on irradiated bone due to compromised natural tissue repair processes [24].…”

“…However, when it comes to assessing the dosage of the toothbearing bone next to the target area, it becomes a complex process that requires the involvement of a radiation oncologist and physicist. Tumors located in the oropharynx, the lower gingiva, and the floor of the mouth in the oral cavity are associated with the highest radiation doses being delivered to the contralateral molar region [23,24].…”