Dental oncology in patients treated with radiation for head and neck cancer

The dentition of head and neck cancer patients is of utmost importance when they receive radiation therapy, especially because patients are living longer after a course of head and neck radiation. Good communication among the oncology team members (the radiation and medical oncologists, the maxillofacial prosthodontist/dental oncologist, otolaryngologist, reconstructive surgeon, nursing support) and the patient is essential initially, and subsequently including the general dentist as well. The maxillofacial prosthodontist/dental oncologist has a very important role to play before, during, and after radiation therapy, to avoid loss of supporting bone and teeth and damage to soft tissues. Each member of the oncology team should have a basic knowledge of the patient's dentition and supporting bony structure, including the numbering of teeth. There are treatment-related issues of concern for the dental oncologist, so the treating oncologist must provide proper information to ensure appropriate dental care. Post-radiation dental care may be assumed by a general dentist for long-term maintenance. The effectiveness of the education of caregivers and head and neck cancer patients in reducing osteoradionecrosis (ORN) has been demonstrated. As the number of patients developing human papilloma virus-related head and neck cancer continues to increase, greater emphasis must be placed on good dental care. The aim of this primer for all those caring for patients with head and neck cancer is to underscore the important role of the dental oncologist during all phases of radiation therapy, and to provide guidelines to minimize and prevent dental complications such as radiation-induced caries and ORN.