Reference guide to oral health for oncology patients

Prevention and management of oral complications

• Head and Neck Radiation Therapy
• Chemotherapy
• Blood and Marrow Transplantation

Head and Neck Radiation Therapy

Patients receiving radiation therapy to the head and neck are at high risk for developing oral complications.

Because of the risk of osteonecrosis in irradiated fields, the only opportunity to perform oral surgery may be before radiation treatment begins. Before treatment, the dentist will consider extracting all potentially problem teeth.

Before Head and Neck Radiation Therapy:

• Refer the patient to a dentist for a pretreatment oral health examination.
• Tell the dentist the treatment plan and timetable.
• Help prevent tooth demineralization and radiation cavities by making sure the patient has a good oral hygiene program and has received instruction on fluoride gel application.
• Allow at least 14 days of healing for any oral surgical procedures.
• Surgical procedures are contraindicated on irradiated bone, so make sure pre-prosthetic surgery is done before treatment begins.

During Radiation Therapy

• Make sure the patient follows the recommended oral hygiene regimen, whether at home or in the hospital.
• Monitor the patient for trismus: Check for pain or weakness in masticating muscles in the radiation field. Instruct the patient to exercise jaw muscles 3 times a day, opening and closing the mouth as far as possible without pain; repeat 20 times.

After Radiation Therapy

• After mucositis subsides, consult with the oral health team about dentures and other appliances. Patients with friable tissues and xerostomia may never be able to wear them again.
• Make sure that the patient follows up with a dentist for fluoride gel/home care compliance and trismus management. Lifelong, daily applications of fluoride gel are needed for patients who are severely xerostomic.
• Advise against oral surgery on irradiated bone because of the risk of osteonecrosis. Tooth extraction, if unavoidable, should be conservative; use antibiotic coverage and possibly hyperbaric oxygen therapy.
• For pediatric patients, consult the dentist to monitor irradiated craniofacial and dental structures for abnormal growth and development.

Pre-Cancer treatmatment

Oral Health Examinatnation

Objectives

• Establish a schedule for dental treatment.

• Begin at least 14 days before cancer therapy starts.
• Postpone elective oral surgical procedures until cancer treatment is completed.

• Identify and treat sites of low-grade and acute oral infections:

• Dental decay.
• Periodontal disease.
• Endodontic disease.
• Mucosal lesions.

• Identify and eliminate sources of oral trauma and irritation such as ill-fitting dentures, orthodontic bands, and other appliances.
• Educate and train patients in preventive oral hygiene:

• Brush gently after every meal and at bedtime; floss daily.
• Use special brushing techniques if the mouth is sore.
• For xerostomia, drink liquids and suck ice chips or sugarless candy.
• Rinse with 1/4 teaspoon baking soda and 1/8 teaspoon salt in 1 cup warm water solution, followed by a plain water rinse.
• Keep dentures clean by soaking them daily in antimicrobial solutions and clean water.
• Remove prostheses if any irritation, mucositis, or ulceration occurs.

• Evaluate dentition and loss of primary teeth in children. Remove loose primary teeth as well as those expected to exfoliate during treatment.