Periodontal therapy for patients before and after radiotherapy: A review of the literature and topics of interest for clinicians

Abstract

BackgroundTo review and discuss important topics regarding periodontal treatment pre- and post-radiotherapy for head and neck cancer in human patients; to discuss the references for adequate techniques, the appropriate moment for tooth extractions and periodontal management; and to discuss the prevention of osteoradionecrosis.Material and MethodsThirty-nine studies including original studies, randomized clinical trials (RCTs) and reviews were searched in online databases MEDLINE (PubMed) and the Cochrane library. No year of publication restriction was applied.ResultsLanguage was restricted to English, and the following Medical Subject Heading terms were used: radiotherapy, radiation therapy and periodontal treatment. Studies regarding periodontal treatment and tooth extraction that involved clinical management of irradiated patients were selected.ConclusionsThe treatment of periodontal diseases before radiotherapy is mainly required to avoid future dental extraction and to reduce the development of osteoradionecrosis. Periodontal treatment in irradiated patients mostly includes scaling and root planing, extraction of condemned teeth and topical and systemic antimicrobial therapy. Tooth removal should be planned at least 14 days before the first day of radiation treatment. Particular care and mouthwashes should be taken during and after radiation.Clinical SignificanceThe management of irradiated patients represents a challenge for health professionals, including dentists. It is important to establish recommendations for clinicians concerning dental and periodontal management in irradiated patients before, during and after treatment. Key words:Head and neck cancer, radiotherapy, periodontal treatment, periodontitis.

Preradiation tooth extraction and jaw osteoradionecrosis: Nationwide population‐based retrospective study in Taiwan

“…First, patients with oral cancer receive a higher dose of RT in their oral cavity than those with non‐oral HNC 6 . Accordingly, more oral complications occur, such as extensive caries, periodontal destruction, xerostomia, oral candida infection and trismus, 8,16 and may result in new teeth with a poor prognosis, jaw bone damage or new sources of infection, all of which can, in turn, increase the ORNJ risk 36 . Second, the aggressive surgical approach required by tumour resection of oral cavity cancer frequently involves the removal of arteries necessary to maintain mandibular blood flow, thus possibly increasing the ORNJ risk 37 .…”

“…One vital aspect of this is the time interval between tooth extraction and the first day of RT, which must be sufficient to allow initial healing of the extraction wound and avoid iatrogenic ORNJ. Most studies have concluded that tooth extraction should be performed at least 7‐21 days before RT 8,12‐16 . However, the wound‐healing time should not be prolonged because this could compromise oncological treatment and prognosis 13,17‐20 …”

“…Most studies have concluded that tooth extraction should be performed at least 7-21 days before RT. 8,[12][13][14][15][16] However, the wound-healing time should not be prolonged because this could compromise oncological treatment and prognosis. 13,[17][18][19][20] This study used 2000-2013 data from the Longitudinal Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) of the Taiwan National Health Insurance (NHI) Administration to retrospectively analyse the ORNJ risk in patients with HNC who underwent tooth extraction 1-21 days before RT, with at least 12 months of follow-up.…”

Multiple aPDT sessions on periodontitis in rats treated with chemotherapy: histomorphometrical, immunohistochemical, immunological and microbiological analyses

“…During such treatment, it is common for changes in the oral cavity to occur: such changes include mucositis, ulceration, gingival bleeding [2],degeneration in oral keratinocytes [3] and altered collagen synthesis [4], as well as changes in connective tissue and the oral microbial environment [5]. Furthermore there is increased destruction of periodontal tissues [6,7] with progressive periodontal attachment loss [8], increased production of proinflammatory cytokines [9] and the remodelling ability of bone and soft tissue is compromised [10].…”

Follow‐up of need for dental treatment in 126 patients who have received radiation treatment to the head and neck region

“…Both acute and long‐term effects of radiation to the head and neck are associated with a decreased quality of life . There is general consensus that patients exposed to radiation to the head and neck need adequate follow‐up to prevent or reduce adverse effects and the need for communication between various caregivers is advocated . It is also important to motivate the patient for subsequent follow‐up, adequate oral hygiene and long‐term use of salivary stimulants/salivary substitutes and fluoride prophylaxis …”