Dental Health and Radiation Therapy
Dear OncoLink "Ask The Experts,"
I have a rare Interdigitating Dendritic Cell Sarcoma of the parotid gland and am starting radiation in a couple of days. I want to know if there is any type of protection I can use to protect my teeth from radiation damage. Someone has suggested putting foil over my teeth where the radiation is administered.
Pinaki R. Dutta, MD, PhD, Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:
You have good reason to be concerned about the health of your teeth. There are a few factors to consider. For starters, what is the current health of your teeth? For our patients undergoing radiation treatments to the head and neck, we have them evaluated by a trained dentist or oral surgeon who is experienced in treating patients with head and neck cancers. Teeth that are not healthy need to be removed. Ideally, any extractions that need to be done should be done well before the radiation starts in order to allow adequate healing. Doing dental extractions during the radiation or afterwards can slow or prevent healing. No matter how good the radiation techniques are to limit dose to the mandible or the maxilla, there is always some dose to these structures during head and neck radiation.
Your teeth rely on a constant flow of fresh saliva to keep them healthy. Saliva contains a variety of antimicrobial agents that keep bacterial growth in check. With cancer of the parotid gland, your salivary flow is already compromised. Radiation will also further dry your mouth and limit your salivary production. For that reason, your dentist should provide you with fluoride trays for both your upper and lower teeth. The fluoride treatments should be done twice a day for a couple of minutes, all throughout your radiation course, and for years afterwards. It has not been studied as to how long people should continue with these treatments. But it is better to be safe than sorry because as mentioned above, teeth extractions are difficult in a post-irradiated mouth.
As for the foil on the teeth, do NOT do it! Any metal in the mouth will cause the radiation to "scatter", which actually increases unwanted dose to the gums and cheeks. This will result in sores or blisters in these areas. In fact, if you have any fillings or caps, I recommend wearing the fluoride trays (without the fluoride paste) during the radiation treatments. If you don't have the trays yet, you can use some cotton rolls between the teeth and cheeks in the areas where there is metal.