I was witness to a sad story in my East Setauket dental office today. A patient whom I had not seen for a year came in for a checkup appointment. In the time I had not seen him, he had undergone radiation treatments and several surgeries for squamous cell carcinomas of his head and neck. Unfortunately his oncologist did not advise him to seek dental care before the treatments began. Nor was he warned of the dental risks associated with radiation therapy. He now has serious dental decay and infections in several teeth.
Oncologists need to tell their patients to visit their dentist before beginning radiation therapy. The oncologist also needs to speak to the patient’s dentist in order to inform the dentist of the type of therapy, the location and dosage and number of treatments. The saliva of these patients is reduced in volume, thus losing its protection against dental decay. I thus want to see these patients on an emergency basis as soon as I learn of pending radiation treatments.
We perform a thorough oral examination, periodontal scaling and root planning and educate the patient about the risks of radiation therapy. We stress with them the importance of meticulous oral hygiene during and after the radiation treatments. I prescribe preventive oral therapies for these patients. We recommend removing any teeth that are questionable. If teeth are removed before radiation therapy, we expect that healing will be normal. But if the teeth are removed after therapy, there is a high chance of osteoradionecrosis – exposed bone and delayed healing. Hyperbaric oxygen may then be delivered to encourage healing. We also restore any decayed teeth. When radiation therapy begins, the patient needs to be fee of infection and decay. We want to see them at frequent intervals to monitor any change in their dental health.