Head and neck cancer patients may experience problems with teeth and oral health due to:
- Destruction by tumor
- Loss of structures as part of treatment (surgery and/ or radiation
- Long term loss of oral health defenses, like saliva and tissue blood flow
Dental providers are key to comprehensive head and neck cancer care.
Engaging with a qualified dental provider may be critical for:
- Prevention: Dental evaluation prior to cancer care aims to reduce the risk of developing dental cavities and diminish the risk for developing a non-healing wound of the jaw following radiation therapy.
- Treatment & Restoration: Evaluation may benefit the planning process for the repair or replacement of teeth or other anatomic structures that might be lost or impacted by a cancer or its treatment. Strategies to optimize oral health may be offered.
- Maintenance & Surveillance: Dental providers may complement monitoring for recurrent or new cancers, and support efforts in reducing further loss of teeth.
Key oral health issues that affect head and neck cancer patients:
Dry mouth (Xerostomia)
Head and neck cancer patients may experience variable degree of dryness of composition protects teeth against dental cavities. loss. Dry mouth (Xerostomia) mouth following treatment (especially radiation).
Six major salivary glands (2 parotid, 2 submandibular, and 2 sublingual glands) produce roughly 90% of our saliva. The salivary flow and its composition protects teeth against dental cavities.
Majority of head and neck radiation therapy fields include major salivary glands. Radiation irreversibly harms salivary glands resulting in lifelong dry mouth. Dry mouth increases risk for dental caries, poor oral health and tooth loss.
Role of Topical Fluoride Gel in preventing dental cavities:
- Applied with customized dental appliances like athletic mouth guards. Must be applied daily and for the rest of the patient’s life
- Diminishes the possibility of developing dental cavities
- Prescribed when one begins radiation therapy
- Application for 5 to 10 minutes following routine brushing and flossing at bedtime
- Spit out excess fluoride following use
- Do not rinse, eat or drink for 30 minutes following use
Osteoradionecrosis is a condition of delayed bone healing or inability for bone to heal following radiation therapy.
Predictable healing requires a healthy blood supply. Radiation can harm the smallest of the blood vessels (called capillaries) in and around the treated with radiation. Extracting teeth following radiation therapy can precipitate osteoradionecrosis. Extraction sites in areas that received high radiation doses do not always heal.
Patients are cautioned against dental extractions following radiation therapy without consulting their radiation oncologist.
Reducing the risk for ORN is possible:
- Diseased teeth should be extracted prior to radiation therapy
- Maintain optimal oral hygiene following radiation therapy
- When extraction of teeth cannot be avoided in a patient with history fo head and neck radiation, use of Hyper-Baric Oxygen (HBO) therapy.
Dry mouth and osteoradionecrosis contribute to increased risk for poor dentition including cavities, dental loss and potential non-healing wounds, pain and jaw fracture.
What to expect:
Before cancer treatment
- You may be asked to see a dentist before starting cancer treatment
- Your dental provider may perform an examination, obtain dental x-rays, and counsel you about the health of your teeth
- You may be requested to consider restoration or removal of diseased teeth to reduce risk of dental complications.
- Strategies for post-treatment ongoing dental care, rehabilitation and restoration may be discussed.
- Impressions/moulds may be made for future use during post-treatment restoration.
After cancer treatment
Head and neck cancer patients, particularly those with teeth and who are treated with radiation therapy, shoudl maintain a relationship wiht a general dentist. In addition to maintaining gum (periodontal) and dental health, a general dentist can restore or replace teeth as needed, including provision for fillings, fixed crowns (caps), bridges and removable dentures.
However, when a patient’s cancer or the care that addressed it results in an oral facial anatomy defect, the services of a maxillofacial prosthodontist or a general prosthodontist are sometimes necessary. These caregivers specialize in rehabilitating patients with complex anatomic defects that influence speech, swallowing and appearance. The prostheses they construct may or may not involve the replacement or restoration of teeth. Their services may include restoration or replacement of teeth, portions of missing jaws and missing facial structures with use of:
- Obturator prostheses that form a partition between the mouth and nose when a portion of the palate (roof of mouth) is missing
- Mandibular resection prostheses that replace missing lower teeth when a portion of the lower jaw is missing
- Speech aid prostheses that replace portions of the soft palate
- Palatal augmentation prostheses that make the palate larger when portions of the tongue are missing
- Facial prostheses
- Eye prostheses
- Nose prostheses
- Ear prostheses
Patients without a relationship with a general dentist should establish one in the interest of:
- Periodic examinations and x-rays
- Periodic cleanings by a general dentist, an oral hygienist, or a gum specialist (periodontist). Dental cleaning may sometimes be requested more frequently than usual.
- Dental restorations as needed
- Lifelong and daily fluoride application for those who had radiation therapy
Take home messages:
- Oral/dental care is integral to management of head and neck cancers
- Patients that require radiation treatments are at higher risk for dental complications
- Regular lifelong engagement with a dental care provider is critically important