Radiotherapy‐induced oral morbidities in head and neck cancer patients

Abstract

The cumulative effect of radiation and the extent of related morbidities on oral tissues are enormous and increase over time. The numerous radiation-related side effects have a strong, negative influence on the oral functions and are responsible for a drastic reduction in the oral-health-related quality of life of the cancer survivors. In a significant deviation to the earlier approach of advising extraction of all remaining teeth before RT, the concept of preserving a maximum number of teeth in a state of health and for better oral functions postcancer cure has been globally accepted and is adhered to. The effects of radiation and their impact on the general well-being of the patients underscore the relevance of understanding the sequelae of radiation therapy on healthy oral tissues, preexisting oral diseases and their progression, impact on oral treatment needs, limitations in performing the indicated treatment, and shortcoming in treatment outcomes. It is vital for the professionals involved in head and neck cancer care to follow a well-devised referral system for oral care before and after RT and educate patients for a life-long follow-up K E Y W O R D S head and neck cancer, oral health, osteoradionecrosis, radiation caries, radiotherapy, trismus 238 wileyonlinelibrary.com/journal/scd Spec Care Dentist. 2020;40:238-250.

Use of dentures, receipt of information, quality of life, and oral function following radiotherapy for head and neck cancer

“…Treatment of head and neck cancer (HNC) with radiotherapy can have long‐term side effects, which can put oral health at risk. Two types of toxicity related to radiotherapy might develop: acute (ie, oral mucositis, loss of taste, dry mouth, and trismus) and chronic (ie, radiation caries and osteoradionecrosis [ORN]) 1 . Further, it is recommended that any teeth with a poor prognosis (eg, nonrestorable and/or periodontally involved teeth) are extracted prior treatment with radiotherapy, especially if they are included in the field of radiation 2 .…”

“…This is to help prevent the need for dental treatment after radiotherapy that might lead to the development of ORN. These recommendations leave a substantial number of HNC survivors with missing teeth, leading to difficulty with chewing, loss of appetite and enjoyment of food, poor speech resulting in problems with communication and reduced quality of life (QoL) 1 …”

The role of exercise therapy in managing post-radiotherapy trismus in head and neck cancer

“… 11 It appears clinically 2 months post-radiotherapy. 12 Bhandari et al. 12 reported that reduced mouth opening is approximately 2%–4% per month at the interincisal opening level.…”

“… 12 Bhandari et al. 12 reported that reduced mouth opening is approximately 2%–4% per month at the interincisal opening level. However, they also reported that the progression in reduced mouth opening might continue for up to 9 months.…”

“…Trismus restricts mouth opening for HNC survivors, which complicates their ability to eat and talk normally. 12 Subsequently, poor QoL may result. 1 , 4 A retrospective hospital-based study found that HNC survivors had an average of 14 missing teeth following radiotherapy.…”