Dental Management of Head and Neck Cancer Patients Treated with Radiotherapy and Chemotherapy

Radiotherapy (RT) induced oral complications are complex, dynamic pathobiological processes that predispose patients to serious clinical disorders. The head and neck region is composed of numerous structures, each with an inherent response to radiation that is largely governed by the presence or absence of mucosa, salivary glands, or specialized organs within that site. Irradiated mucocutaneous tissues demonstrate increased vascular permeability that leads to fibrin deposition, subsequent collagen formation, and eventual fibrosis. Irradiated salivary tissue degenerates after relatively small doses, leading to markedly diminished salivary output. Radiotherapy-induced damage in the oral cavity is due to harmful effects of radiation on oral mucosa, dentition, salivary glands, masticatory musculature and bone. Thus, timely treatment planning and prevention is important and needs to be done before radiotherapy to avoid complications such as osteoradionecrosis (ORN). Chemotherapy may be administered as an adjunct to RT. Patients undergoing concurrent chemotherapy and RT are at greater risk for oral mucositis and secondary oral infections such as candidiasis.