Department of Veterans Affairs Consensus: Preradiation dental treatment guidelines for patients with head and neck cancer

Abstract

Few protocols have been published for the dental management of patients with head and neck cancer to prevent complications from head and neck radiation therapy. Radiation therapy not only affects the tumor cells targeted, but also the dentition, bone, salivary gland, and oral soft tissue structures. A comprehensive dental evaluation prior to head and neck radiation therapy can help prevent many complications. The following clinical guidelines were established by a workgroup of oral health providers within the Department of Veterans Affairs. This workgroup focused on developing a set of recommendations regarding dental care prior to the initiation of head and neck radiation therapy based on the best clinical evidence and expert consensus. A systematic algorithm was developed for the evaluation including pre‐exam data gathering, examination, education, and treatment, followed by maintenance and postradiation dental follow‐up. This document is evidence‐based, patient‐centered, consistent with accepted practices of care and safety, and in accordance with applicable statutes and regulations.

Oral care and protocols in cancer patients

“…Any discomfort or trauma to the mouth should be addressed and avoided. 10 When there are time constraints for a complete dental evaluation and treatment protocol in case of intensive chemotherapy, partial dental evaluation and treatment protocols with minor caries, asymptomatic third molars or asymptomatic teeth without excessive probing with depth >8 mm, mobility I or II, or periapical lesions of 5 mm are a viable option. In post-head and neck radiation patients who are compliant fluoride users, the use of chlorhexidine, fluoride mouth rinses, composite resin, resinmodified glass ionomer cement, and amalgam restorations over traditional glass ionomer cement is suggested.…”

Strategies for the dentist management of cancer patients: narrative literature review

“…The dental surgeon must diagnose and treat the RT acute oral toxicities 24 (OM [25][26][27] , dysgeusia, 12,22,28,29 infections, pain, and xerostomia) (Table 3), that implicate an inability to eat, speak, clean, increased costs with hospitalization, and reduced quality of life. [30][31][32][33] Nutritional care, constant water intake, and use of salivary substitutes are recommended 12,93 In a recent study, the use of zinc-L-carnosine demonstrated encouraging results in the treatment of dysgeusia in these patients 94…”

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“…The dental surgeon must diagnose and treat the RT acute oral toxicities 24 (OM [25][26][27] , dysgeusia, 12,22,28,29 infections, pain, and xerostomia) (Table 3), that implicate an inability to eat, speak, clean, increased costs with hospitalization, and reduced quality of life. [30][31][32][33] Nutritional care, constant water intake, and use of salivary substitutes are recommended 12,93 In a recent study, the use of zinc-L-carnosine demonstrated encouraging results in the treatment of dysgeusia in these patients 94…”