Dental aspects of the problems, care, and treatment of the irradiated oral cancer patient

Importance of a dental approach in head and neck cancer therapy

“…10,29 The initial symptoms of irradiation in the oral cavity are sensitivity of the teeth to external stimuli, primary erosion of the occlusal/incisal surfaces of the teeth, and gingivitis. The irradiation may directly affect the inorganic-organic components of the teeth, and may cause more rapid decalcification that progress very quickly to necrosis, which usually spreads via periodontal ligament, and causes more tooth loss and greater periodontal attachment loss.…”

“…30,31 Rapidly developing decays around the tooth neck lead to complete amputation of the tooth. 2,29,32 Additionally, a decrease in the pH and the buffering/enamel remineralizing properties of the saliva, reduced mastication and poor oral hygiene are other inducers of radiation caries. 2,10,29,32…”

“…10,29 The high inorganized content of the bone, especially in the mandible, 25 absorbs the primary radiation 2,29 and releases the absorbed radiation over time, causing secondary irradiation of the inner periosteum. 29 Consequently, the soft and bony tissues become hypoxic-hypocellularhypovascular; and microorganisms or trauma causes tissue breakdown that results with chronic, non-healing ulcer.…”

“…10,29 The high inorganized content of the bone, especially in the mandible, 25 absorbs the primary radiation 2,29 and releases the absorbed radiation over time, causing secondary irradiation of the inner periosteum. 29 Consequently, the soft and bony tissues become hypoxic-hypocellularhypovascular; and microorganisms or trauma causes tissue breakdown that results with chronic, non-healing ulcer. 33,34 Irradiation also depresses the growth of the teeth and the bones in children, 22,[35][36][37] depending on the type/ location of the tumor, the age, dental/oral status and the level of routine dental care of the patient, the dose of the radiotherapy, and the extent of the chemotherapy.…”

“…7,25 However, the decision to teeth extract teeth should take into account the status of the dentition, the periodontal prognosis, the level of the dental consciousness of the patient, and the immediacy of the radiotherapy. 2,7,10,40 Some authors advocate the removal of all teeth within the field of radiotherapy 7,29 and the carious, periodontally involved teeth 2,5,7,10,25,29,40 in order to prevent serious problems which may be observed with any surgical process after radiotherapy. As periodontal tissues are sensitive to radiation, escalated risk of periodontal destruction and consequent tooth loss during/ after cancer therapy may be likely for patients with poor oral hygiene.…”