Dental Work Prior To Head And Neck Radiation
Dear OncoLink "Ask the Experts,"
My mother had a tumor removed from a salivary gland in her lower lip. The margins were not free and she is to have radiation on the entire lower left jaw and chin. She is 79 years old and is scheduled to have all her lower teeth removed. They say she will probably not get false teeth for 6-12 months from now and she is questioning whether this is something she should do at her age. The radiation treatment sounds pretty tough and she is very apprehensive.
David I. Rosenthal, MD, Director for Head and Neck Radiation Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:
Thank you for your question.
Radiation therapy is commonly recommended postoperatively for high-grade parotid salivary cancers with high risk factors including compromised margins of resection because of tumor infiltration, the nature of parotid surgery around the facial nerve, perineural invasion, and nodal metastases. The consequences of locoregional recurrence may be devastating, dire, life-threatening or fatal depending on how, when and exactly where the recurrence is located.
The goal of radiation therapy is to optimize locoregional control, and hopefully overall survival. The radiation therapy is generally given on one side of the head or neck, as there are infrequent indications for treatment of the opposite side. Accordingly, the radiation therapy side effects are limited to one side. Radiation therapy does cause mucositis (inflammation of the mucous membranes) and xerostomia (dry mouth). The opposite side salivary glands remain functional, so the severity is not as great as for patients receiving bilateral radiation therapy as required for some other head and neck cancers. Since saliva is the first line of defense against cavities, the more dry mouth the much greater risk for cavities. This is why patients require pre-radiation therapy dental consultation and treatment by a dental medicine expert radiation therapy familiar with radiation therapy issues. At the minimum, patients generally require daily life-long fluoride treatments along with a supervised rigorous dental hygiene regimen. Problematic teeth, as defined by the dental consultant, within the radiation treatment area may need restoration or, if not restorable, extraction before radiation therapy to minimize the later risk for jaw problems, including osteoradionecrosis (bone destruction). This is why it is ideal for patients to be treated at centers of excellence with a head and neck multimodality cancer team to insure they receive optimal surgical treatment, radiation therapy and supportive ancillary care.
Specific treatment plans must be defined for individual patients accounting for their performance status, physiologic reserve, tumor and surgical treatment characteristics, social and psychological circumstances.