The dental management of patients irradiated for head and neck cancer - Clinical Open - Verifiable CPD paper

Sep 24, 2026

Uploaded by Ophelia

Patients undergoing radiotherapy for head and neck cancers develop multiple oral complications, including mucositis, trismus, xerostomia, radiation caries, and osteoradionecrosis. The paper details preventive, restorative, and rehabilitative management strategies tailored to these risks, and outlines clinical considerations for preventing and treating treatment-related complications. It emphasizes the need for coordinated multidisciplinary care and highlights areas where evidence remains insufficient.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Key points

Dental complications in irradiated patients

Role of the multidisciplinary team

Research needs for clinical decisions

Abstract

Introduction

Mechanisms and oral radiation syndromes

Pre-radiotherapy

Dental assessment

Risk factors and clinical planning

Prevention and restorations

CLINICAL OPEN | VERIFIABLE CPD PAPER Head and neck cancer The dental management of patients irradiated for head and neck cancer Elizabeth Z. Goh,*1 Nicholas Beech,1 Nigel R. Johnson1,2,3 and Martin Batstone1,4 Key points Patients undergoing radiotherapy for head and neck cancers are prone to a range of dental complications, including mucositis, trismus, xerostomia, radiation caries and osteoradionecrosis. The multidisciplinary team plays a central role in the preventive, restorative and rehabilitative management of irradiated head and neck cancer patients. Further research is required to support decisions around pre-radiotherapy extractions, implant placement in irradiated bone, and the treatment and prevention of osteoradionecrosis. Abstract Patients undergoing radiotherapy for head and neck cancers are prone to a range of dental complications, including mucositis, trismus, xerostomia, radiation caries and osteoradionecrosis. Specific considerations include the preventive, restorative and rehabilitative management of such patients, and the prevention and treatment of complications. This article aims to highlight the current understanding and management of dental needs for patients who have had or will undergo radiotherapy. Introduction Radiotherapy for head and neck cancers utilises ionising radiation to damage the genetic material of vulnerable malignant cells and cause cell death. Adverse effects arise from the same mechanisms damaging normal cells, especially those which are rapidly dividing or less capable of repair. In the oral cavity, these can be cells of the mucous membranes, underlying soft tissue, salivary glands, teeth, periosteum, bone and vasculature. This results in specific radiation syndromes: xerostomia from salivary gland injury; mucositis from epithelial damage; trismus from collagen structure changes; radiation caries from pathological alterations in tooth structure and normal flora; and osteoradionecrosis (ORN) from reduced bone healing capacity. 1Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; 2School of Dentistry, University of Queensland, Brisbane, Queensland, Australia; 3Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; 4Oral and Maxillofacial Department, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia. *Correspondence to: Elizabeth Z. Goh Email address: [elizabeth.goh@uq. net.au](elizabeth.goh@uq. net.au) Refereed Paper. Submitted 10 November 2022 Revised 10 February 2023 Accepted 3 March 2023 [https://doi.org/10.1038/s41415-023-5864-z](https://doi.org/10.1038/s41415-023-5864-z) Management of oral health is paramount for head and neck cancer patients, as dental complications are common . Important considerations include specific preventive, restorative and rehabilitative management, and the prevention and treatment of complications. Since our first article,1 the past decade has seen increasing use of dental implants and landmark ORN clinical trials. In this article, we aim to provide an update on the current management of dental needs for patients who have had or will undergo radiotherapy. Pre-radiotherapy Dental assessment A multidisciplinary team (MDT) approach to managing head and neck cancer patients is considered best practice.2 Given the oral implications of the disease and its treatment, the MDT should include dental practitioners with expertise in the preventive, restorative and rehabilitative management of these patients.2 MDT variations can be expected internationally.2 For example, in the UK, both pre-treatment assessment and post-surgical rehabilitation are performed by specialist restorative dentists in the MDT, while in Australia, this is commonly performed by experienced general dentists and specialist prosthodontists. While abiding by local standard care pathways is important, the principles of care remain the same. Ideally, every patient r

FAQs

Why are dental complications common in head and neck cancer patients receiving radiotherapy?

Radiotherapy damages not only malignant cells but also vulnerable normal tissues in the oral cavity. This leads to characteristic syndromes such as xerostomia, mucositis, trismus, radiation caries, and osteoradionecrosis.

What is the role of the multidisciplinary team in managing irradiated patients?

A multidisciplinary team is central to preventive, restorative, and rehabilitative care. It supports coordinated decision-making to manage oral health needs and complications.

What key decisions require further research before radiotherapy?

Further research is needed to guide decisions such as pre-radiotherapy extractions, implant placement in irradiated bone, and approaches for treatment and prevention of osteoradionecrosis.

Sep 24, 2026

Uploaded by Ophelia