Pre-Radiation Dental Consultation

Why is a Pre-Radiation Dental Evaluation Important?

When the treatment for cancer of the head and neck requires radiation therapy, a thorough dental examination before treatment begins, by a dentist trained in this area, can help patients avoid many complications and achieve optimal results.

The goal of the pre-radiation dental evaluation is to avoid or minimize post-radiation complications. By precluding many complications that could jeopardize treatment options and slow recovery, a thorough pre-radiation dental examination by a maxillofacial prosthodontist is very important.

Dr. Gulbransen and Dr. Recksiedler are trained in Maxillofacial Prosthodontics, a subspecialty of Prosthodontics.  All Maxillofacial Prosthodontists are prosthodontists first and then attain a fellowship training (one-year) exclusively in Maxillofacial Prosthetics. Following graduation from dental school, Dr. Gulbransen and Dr. Recksiedler both completed a prosthodontic training program at the Los Angeles Wadsworth VA Hospital and then completed a one-year fellowship training in maxillofacial prosthetics at the UCLA Medical School. This is where they learned to rehabilitate patients with oral and facial defects caused by cancer or trauma.

To understand why it is imperative to have a pre-radiation evaluation, it is first necessary to understand how radiation affects the oral cavity, salivary glands, teeth and bone.

Because it is very difficult to exclude the salivary glands from the radiation fields in the head and neck, radiation therapy may affect the salivary glands and the result is a change in the quantity and quality of the saliva. Saliva is important when discussing oral health because it both lubricates the mouth and balances the mouth’s acidity, thereby preventing tooth decay. As a result of radiation, most patients experience dryness in the mouth, called xerostomia.

A certain amount of dryness will probably persist forever after radiation therapy to the head and neck. The most common problem associated with dry mouth is rampant dental decay and periodontal (gum) disease.  DAILY application of fluoride has been shown to be effective in preventing these problems. If a patient is not compliant, dental disease, oral infections and infections of the jaw bone are common problems.

Another more serious effect of radiation is to decrease the size and number of blood vessels in the area of radiation. This causes a decrease in the ability of irradiated tissue and bone to heal following surgery, injury or infection. Post-radiation infections can be very serious with prolonged healing times, occasionally resulting in osteoradionecrosis.

For this reason, it is very important to thoroughly evaluate a patient’s dentition prior to radiation. To avoid future complications after radiation of the head and neck, any questionable teeth within the field of radiation may need to be extracted prior to initiation of radiotherapy. Extraction of teeth following radiotherapy could place the patient at risk for infections and osteoradionecrosis.

In addition, during the pre-radiation evaluation, custom topical fluoride trays are fabricated. These trays allow application of topical fluoride daily to help decrease the incidence of dental caries and infection. Patients should also be aware of the need for meticulous oral hygiene, as remaining teeth are usually at risk for dental caries secondary to their xerostomia, or lack of saliva. Long-term maintenance includes three-month visits to the family dentist or periodontist for cleaning and checkups. This is a lifelong commitment that patients need to make for optimal oral health.

If you have any questions, please contact our office for assistance.