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Dental treatment forms a very important part of pre-cancer evaluation and therapy that a patient undergoes, especially if the lesion is located in the head and neck region. Here are some things that you need to be aware of.

Patients that have been diagnosed with cancers of the head and neck are often treated aggressively without waiting for any longer than necessary. This can make it difficult to fully prepare yourself or take the necessary precautions to avoid any unwanted effects of radiation.

Oral care during cancer treatment and ideally, before it begins, is a very important aspect of pre-cancer precautionary steps that the patient must take. Some of the side effects of cancer treatment include dryness of the mouth, inflammation of the gums, tongue and other soft tissues of the mouth, rapid onset and spread of decay, gum disease and other opportunistic infections.

Luckily, most of these complications can be avoided or minimized with the proper steps taken before the radiation treatment actually starts [1,2].

Dental Checkup Before Radiation

Even if your oncologist or radiation center does not recommend a dental check-up before receiving radiation to the head and neck region, you absolutely must schedule it yourself. Your dentist will do a complete clinical checkup as well as take a panoramic radiograph to check for any pockets of infection that might exist.

Dental treatment for cancer patients is carried out aggressively because any small problems right now will only worsen and taking care of them later may be extremely difficult. If it is possible, the dental treatment should be done at least a month before radiation starts so that any healing that has to take place is completed beforehand. However, the urgency of the situation does not always allow for such luxury [3].

Dental Treatment Before Radiation Starts

Extractions

Any teeth that require time-consuming endodontic work like root canals, teeth that show evidence of infection around the roots in the X-ray, teeth that have periodontal pockets or maybe even require a deep filling with a moderately positive prognosis should all be extracted [4].

One of the main complications that occur after getting radiation therapy is osteoradionecrosis. This is a condition in which the bone does not heal as it normally would after any kind of injury. This is also the reason why extractions are absolutely contraindicated after radiation therapy has been carried out for a minimum of six months. Osteoradionecrosis can even occur up to 25 years after radiation therapy [5].

Removal Of Any Potential Irritants From The Mouth

The soft tissues of the mouth become very susceptible to even the slightest of irritants in the mouth and so any orthodontic bands or appliances, removable dentures or fixed prosthesis with sharp edges should be removed from the mouth.

Even teeth that have sharp edges need to be rounded off to avoid them becoming a source of minor trauma resulting in non-healing ulcers [6].

Scaling

A scaling procedure must be carried out before the radiation begins to remove any plaque and tartar that may have accumulated on the teeth. Even relatively small amounts of plaque and tartar can cause the gums to swell up, bleed and eventually cause the rapid onset of gum disease to set in.

Scaling is something that is recommended to be carried out more regularly than in non-cancer affected patients because it is the only procedure that will help prevent tooth decay, periodontal disease and a host of other problems from setting in [7].

Fluoride Use

Fluoride containing mouthwashes, toothpaste or gels are known to prevent and minimize the occurrence of tooth decay and thus they should be used before and during radiation therapy. Your dentist will help guide you as to which products are the best for this case since commercially available mouth rinses and toothpaste do not have the amount of fluoride required.

It is also recommended that patients apply a 1.1% sodium fluoride gel to the surface of their teeth for 15-20 minutes daily a week before and during the time of radiation [8].

The reason why such aggressive use of fluorides is recommended for oral care during cancer treatment is because of the loss or reduction of salivary production during radiation. The normal production of saliva is absolutely essential in protecting the teeth from decay and often by the time the patient realizes that they are suffering from a dry mouth, a large number of teeth have already been affected [9].

Oral Care Habits To Be Followed During Cancer Treatment

So you want to know how to look after your mouth and teeth during cancer treatment? The teeth should be brushed after every meal using a soft bristled toothbrush. If even this toothbrush causes pain and discomfort you can rinse it in warm water beforehand to make it slightly softer. All candy, sweets or other highly sweet foods should be avoided. Any kind of alcohol, tobacco, and spicy food should also be abstained from. The recommended mouth rinse should be used several times a day [10].

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