Dental Assessment for Patients Having Radiotherapy for Head and Neck Cancer

Who is this leaflet for? What is its aim?

We have given you this leaflet as you have been recommended to have radiotherapy to the head and neck area.

Radiotherapy to the head and neck area permanently weakens the jaw bones (including teeth) and can affect the blood supply in this area. In addition, saliva production and quality is usually permanently reduced. Saliva helps to keep the mouth clean, so both these factors can increase the risk of infection and tooth decay inside your mouth. This can become particularly serious if the jawbone becomes affected. Occasionally, this can lead to a rare condition called osteo-radionecrosis (permanent destruction of the bone).

We take care when planning your radiotherapy to reduce any risk. There are also some important steps you can take to reduce the risk yourself.

Preventative advice

Firstly, you will have a dental assessment with the hospital Restorative Dentistry team. This appointment will include a dental x-ray known as an orthopantomogram (an OPG) and an examination of your mouth and teeth by the specialist Restorative Dentistry team in Clinic 8, Outpatients, Level 3. The assessment will identify if you have any factors that might increase your risk of dental decay or infection during or after radiotherapy. They will offer you extraction of these teeth prior to the radiotherapy. This is to minimise your long-term risk of damage.

• If extractions are recommended, these should be undertaken before radiotherapy begins.
• You should use high fluoride (5000ppm) toothpaste and an alcohol-free 0.05% sodium fluoride mouthwash indefinitely, to reduce the risk of dental decay. Please ask if you have not been prescribed these yet. This is standard advice for all head and neck radiotherapy patients.
• You should clean your teeth twice daily with a soft, medium or small head toothbrush. Use the high fluoride toothpaste. Avoid rinsing, eating or drinking for 30 minutes after using the toothpaste.
• You can gently brush your tongue if not too painful.
• Store your toothbrush head up and allow to air dry. Change your toothbrush every 3 months.
• Remove dentures/removable plates at least twice a day. Do it after each meal and clean them with tap water and a toothbrush. Soak them in their usual solution and leave them to air dry. Store them in water in a closed container overnight. Leave your dentures out as much as possible. You may not be able to wear them at the end of radiotherapy treatment until you stop having side effects.
• During radiotherapy avoid going to the dentist except in an emergency. Please ask your radiotherapy team for advice.
• You can find detailed information to help you with mouth and dental care in the patient information leaflet ‘Radiotherapy for head and neck cancer’ PIN0810. We will give you a copy during your appointment with the oncology team.

Osteo-Radionecrosis

This is rare, but can be an unpleasant side effect of radiotherapy to the jaw bone. It usually does not cause symptoms but can be a problem if there is an infection, which can lead to damage to the jaw bone.

After radiotherapy treatment is completed, you will have a life-long risk of osteo-radionecrosis when teeth are extracted, particularly any from the lower jaw. This is why we recommend extraction of any ‘at risk’ teeth before radiotherapy begins.

To reduce this risk further, please note that following radiotherapy it is very important that you attend routine appointments for maintenance and straightforward dental treatment with your local dentist. If you need dental extractions in the future this may need to be discussed with, and / or performed by, a consultant in Restorative Dentistry or under an Oral and Maxillofacial Surgery team at the hospital.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.