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Can cancer patients undergo root canal treatment? Is there anything different about such a procedure for cancer patients? These and other questions about root canal treatment in cancer patients answered.

Root canal treatment involves the cleaning, shaping, and filling of the canal(s) that carry the nerve endings of the teeth. The reasons why a root canal procedure may be performed are varied and include tooth decay, fracture, worn out teeth, acutely sensitive teeth and more [1].

Patients who are suffering from cancer end up going through radiation therapy, chemotherapy, or a combination of the two. There are many expected side-effects with these modes of treatment and an increase in dental problems is one of them [2].

Root canals in cancer patients

A lot of cancer patients end up needing a lot of dental treatment because they do not know and have not been educated about the possible side effects of cancer treatment on their dental health. Direct radiation to the head and neck area or the systemic use of chemotherapeutic drugs can lead to a decrease in salivation [3].

Patients will often complain of a dry mouth, difficulty in chewing the food, an uncomfortable feeling during swallowing, and a burning sensation in the mouth. This decrease in the amount of spit being made leads to a direct increase in the growth of disease-causing bacteria and thus a rapid spread of tooth decay [4]. 

Another rumor that has been gaining a surprising amount of traction on the internet is about root canal treatment causing cancer. This is something akin to saying that the world is flat and has no link to reality. Let’s just leave it at that.

Root canal treatment in cancer patients is also required a lot of the time, because removal of the teeth during radiotherapy to the head and neck area or during chemotherapy is absolutely contra-indicated. A condition called as osteoradionecrosis can occur and lead to a life-threatening condition which requires long-term admission in the hospital to treat completely [5].

Is root canal treatment successful in cancer patients?

The method by which root canal treatment is provided in a cancer patient is absolutely the same as any other patient. The instruments used do no venture outside the length of the tooth and only the micro-organisms living in the root canals need to be eliminated [6].

The need for antibiotic coverage may or may not arise depending upon the clinical situation. The only thing to be careful about from a dentist's point of view is to ensure that no over-instrumentation is done. An injury to the ligament and bone surrounding the tooth can be slow to heal and cause symptoms similar to Osteoradionecrosis in severe cases [7].

The success rate of root canals in cancer patients is similar to anyone else, but some studies have found a higher incidence of failure in the long term [8]. That could be due to a difficulty in maintaining good oral hygiene or a depression of the immune system allowing resistant disease-causing micro-organisms to grow.  

Should cancer patients get root canal treatment before, during or after cancer treatment?

The treatment approach to a patient diagnosed with cancer but has not yet started cancer treatment is very different than the treatment of a cancer patient already receiving cancer treatment [9].

A dental check-up is now mandated as one of the pre-cancer treatment checks that a patient has to get done. If teeth requiring root canal treatment are found during such a checkup, the dentist has to ascertain the importance of the tooth functionally and esthetically, gauge the amount of time available for dental treatment, and then make a call whether to try and save the tooth or to remove it [10].

If the cancer treatment has to be started immediately then a dentist may opt for the aggressive option of removing the tooth rather than spending time trying to save it. The same is the case in a tooth the patient may have trouble with during cancer treatment.

If, however, a patient has already started cancer treatment then removal of the teeth is completely out of the question. Then even root stumps which have no functional purpose in the mouth are root canal treated and left inside the jaws.

For a patient that is seeking dental treatment after completing cancer treatment, the most important variable is the time that has elapsed since completion of cancer treatment. No tooth removal procedures are advised for about six months to a year for patients that have undergone radiotherapy or chemotherapy so saving any painful tooth or tooth fragment is the first choice of treatment [11].     

Conclusion

Cancer patients can and often need to undergo root canal treatment. The choice of saving a tooth or having it removed is often not available to cancer patients because of the risk of osteoradionecrosis. False information calling for the removal of all root canal treated teeth in cancer patients or trying to pinpoint root canal treatment as the cause of cancer should be ignored without a second thought.    

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