Radiation Therapy, Dental Implications and Care

• xerostomia
• cavities
• osteoradionecrosis
• specific preventive actions and products
  • xerostomia
  • cavity prevention
  • osteoradionecrosis
  • general health and healing
  • regular dental visits

Radiation therapy is used to kill cancer cells (diagnostic radiation is used to view teeth and bones).  The most common form of radiation therapy is machine radiation, which focuses a small beam of radiation directly at the tumor.  Radiation kills all the cancer cells in the beam's focus.  The radiation beam goes through the body and the tumor, without killing all the cells along its path.  To kill only the tumor, health workers control the machine so the radiation beam rotates.  As the beam rotates, it remains focused on the tumor area long enough to be lethal.  The surrounding healthy cells receive some radiation.  Side effects of radiation therapy in the head and neck area can include nausea, skin redness in the tumor area, xerostomia (dry mouth), increased cavities, and osteoradionecrosis (ORN).

Xerostomia  

Xerostomia, the technical term for dry mouth, is the result of the radiation affecting the salivary glands.  In much the same way dry eyes can be uncomfortable, so is a dry mouth.  Beyond being merely uncomfortable, the dryness can lead to severe decay unless specific preventive actions are taken.

Cavities  

Cavities cannot occur unless bacteria are present.  Decreased saliva significantly increases the likelihood of cavities.

Osteoradionecrosis  

Osteoradionecrosis is the death of previously radiated bone. People who have had radiation treatment to their jaws for cancer become predisposed to this condition. Radiation causes bone to become less cellular, less vascular and have less oxygen. This results in a compromised ability of the bone to heal after a traumatic event. Because radiation also destroys salivary gland function and dental decay is more likely to occur in the absence of active salivary flow, a common traumatic event is the extraction of a tooth (because of severe decay). Unfortunately, the otherwise innocent removal of a tooth from an irradiated jaw very often results in osteoradionecrosis (ORN).

Specific Preventive Actions and Products

• xerostomia
  • special toothpaste, rinse, gum, gel,Biotene, available in drug stores
  • Smints mints andXylimax gum contain xylitol and will not cause cavities
  • drink lots of water (water popsicles work well)
  • avoid caffeine (tea, soda, coffee)
  • be aware that many medications cause dry mouth and may increase the dryness
  • prescription medications to increase saliva flow
    • Salagen 5 mg (pilocarpine HCl)
    • Evoxac 30 mg (cevimeline HCl)
  • don't use tobacco or alcohol, they dry out the mouth
  • be aware that spicy or salty foods may cause pain in a dry mouth
  • use a humidifier at night
  • if your dry mouth is caused by medicine, perhaps your medication can be adjusted or changed
• cavity prevention (also keeps the gums healthy!)
  • custom fluoride trays and dental office strength fluoride (9,000 ppm), NuPro Neutral Sodium Topical Fluoride gel
  • extremely effective plaque removal (food gets off teeth easily, plaque is the main concern)
    • floss effectively to remove plaque every time you brush or eat
    • brush thoroughly and effectively
      • disclosing tablets/solution
      • dry brushing
  • Waterpik to help rinse out, kill bacteria, and change the micro-environment to prevent plaque bacteria
  • keep mouth moist, stimulate saliva - see above to help with xerostomia
• osteoradionecrosis
  • learn to be effective in removing plaque completely to avoid dental (tooth, gum, bone) problems
  • ALL preventive dental work done prior to radiation therapy
    • large fillings that very likely will require crowns later, done prior to radiation therapy
    • any anticipated extractions (wisdom teeth, unsalvageable teeth) done prior to radiation therapy
  • carefully consider any oral surgery, especially involving bone, if required after radiation therapy
• general health and healing
  • eat nutritiously
  • supplement your diet with vitamins and minerals (even if you feel you eat well), especially water soluble vitamins [B complex, C] (since you are drinking more water) and antioxidants [E] - always take a multivitamin/multimineral, then add the others - you may require a liquid product if you have difficulty swallowing and/or feeling after surgery ( Ensure Plus HN liquid supplement)
  • exercise for health, circulation, mental well-being, improved sleep
• regular dental visits 
  • visit your dentist every 3 months, and after a year, if your plaque control is excellent, then the checkup interval can be re-evaluated for 4 months and later for 6 months