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Salivary gland damage is the most common adverse effect associated with radiation therapy to the head and neck. A combination of hyposalivation and dietary changes, with a reduced emphasis on oral hygiene practices can contribute to a massive increase in a person's caries risk status. This can be further complicated by limited mouth opening. To enable optimal dental care for head and neck cancer patients before, during and after radiation therapy, patients must be informed and educated about the potential risks of dental caries and the preventive strategies available. All patients should receive a pre-radiotherapy dental assessment by a Restorative Dentistry Consultant. This information will be delivered to the patient, often at an emotionally charged time, and can be lost amongst all the information related to other aspects of his/her cancer management. General Dental Practitioners (GDPs) are therefore in a pivotal position to reiterate this information post radiation therapy and ensure compliance with preventive strategies, with the overall aim to improve quality of life and avoid the need for future extractions and the resulting risk of osteoradionecrosis.
CPD/Clinical Relevance: This article highlights the GDP's role in the shared management of head and neck cancer patients who have received radiotherapy as part of their cancer treatment. The critical issue of dental caries, one of the late effects of radiation-induced hyposalivation, will be focused upon. Other side-effects, such as trismus and osteoradionecrosis, will also be discussed. This article aims to supply GDPs with accurate information to provide to their patients with post radiation therapy, whilst highlighting what treatment is within their remit and when it may be appropriate to refer.
Article
Salivary gland damage is the most common adverse effect associated with radiation therapy to the head and neck.1 Salivary flow decreases rapidly during the first week of treatment, followed by fibrosis of the glands and permanent loss of secretory capacity. This can result in a dramatically diminished quality of life.1,2 The discomfort of reduced salivary flow is compounded by severe inflammation and ulceration of the oral mucosa cavity, a condition called mucositis (Figure 1). This usually begins after the first two weeks of radiotherapy, and improves after a few weeks following completion of treatment.
The degree of salivary gland damage is dependent on the volume of tissue irradiated and the total dose administered, and results in both a quantitative and qualitative effect on saliva production. Doses above 20 Grays (Gy) are associated with the loss of up to 90% of salivary acinar cells3 and head and neck cancer (HNC) patients usually receive doses as high as 70 Grays.
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