Periodontal Treatment After Radiotherapy

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I'AIt I 5 ■ I'reatnient of I'critnlanUil I disease to dental health personnel.''4' 4 The extent and severity ol mucositis, dermatitis, xerostomia, dysphagia, gustatory alteration, radiation caries, vascular changes, trismus, temporomandibular joint degeneration, and periodontal change depend on a myriad of radiation factors: the type* of radiation used, fields ol irradiation, number of ports, types ot tissues in the fields, and dosage.

Patients scheduled to receive head and neck radiation therapy require dental consultation at the earliest possible time to reduce the morbidity of the known perioral side effects. Preirradiation treatment depends on the patient's

Patient With Teeth

Fig. 38-2 Radiographs ol the anterior teeth oi a 52-year-old man with postirradiation caries. Patient received 6000 cGy radiation to the posterior mandible and hase of tongue for squamous cell carcinoma. Radiation caries developed within 1 year of radiation treatment, affecting the cervical areas and incisdl edges of the anterior teeth.

Fig. 38-2 Radiographs ol the anterior teeth oi a 52-year-old man with postirradiation caries. Patient received 6000 cGy radiation to the posterior mandible and hase of tongue for squamous cell carcinoma. Radiation caries developed within 1 year of radiation treatment, affecting the cervical areas and incisdl edges of the anterior teeth.

Sextants Dentitions
Fig. 38-3 Radiographs of the posterior sextants of the same patient <»s in Fig. 38-2. Caries affects the cervical areas and cusp tips of the posterior teeth.

prognosis, compliance, and residual dentition in addition to the fields, ports, close, and immediacy of radiotherapy. The initial visit should include panoramic and intraoral radiographs, a clinical dental examination, a periodontal evaluation, and a physician consultation. I he physician should be asked about the amount of radiation to be administered, extent and location of the lesion, nature of any surgical procedures already performed or to be performed, number of radiation ports, exact fields to be irradiated, mode of radiation therapy, and patient's prognosis (i.e., the likelihood of metastasis). Preirradiation treatment should commence immediately after the physician consultation. The first decision that should be made relates to possible extractions because radiation can cause side effects that interfere with healing.

lor head and nec k squamous cell carcinomas, the radiation dose is usually 5000 to 7000 c(iy (centigrays; 1 c(»y 1 rad) delivered in a fractionated method (150 to 200 cCiy/day over a 6- to 7-week course)."iM This is considered full-course radiation treatment, and the degree of perioral side effects depends on which tissues are irradiated; that is, the radiation fields. It this dose is administered to the salivary gland tissues, xerostomia will ensue. The parotid is the most radiosensitive of the salivary glands; saliva may become extremely viscous or nonexistent, depending on the dose delivered to the particular gland. Xerostomia causes a decrease in the normal salivary cleansing mechanisms, buffering capacity of saliva, and pi I of oral fluids.Oral bacterial populations shift to preponderantly cariogenic forms (e.g., Streptococcus ¡nutans, Actinomyces spp., and Lactobacillus spp.). Radiation-induced caries may progress very rapidly and affects primarily smooth tooth surfaces (1'igs. .38-2 and 3K-3).

High-dose radiation therapy results in liypc»vascularity of irradiated tissues with a reduction in wound healing capacity.Most severe among the resulting oral complications is osteoradionecrosis (ORN). Decreased vascularity renders the bone less capable ol resolving trauma or infection. Such events may cause severe destruction of bone. I he risk of ORN continues for the remainder of the patient's life and does not decrease with time.u

Periodontal disease can be a precipitating factor in ORN.*-'1 Tooth extraction after radiation treatment involves a high risk ot developing ORN, and surgical Hap procedures are generally discouraged after radiation. For these reasons, it is important that the clinician address the patient's periodontal disease before radiation begins, whenever possible. Teeth that are nonrestorahle or severely periodontally diseased should be extracted, ideally at least 2 weeks before radiation/0 Extractions should be performed in a manner that allows primary closure. Mu-copeiiosteal Maps should he gently elevated, teeth should I be extracted in segments; alveolectomy should he performed, allowing no rough bony spicules to remain; and primary closure should be provided without tension. It is unnecessary to extract teeth that can be re- I tained with conservative restorative, endodontic, or peri- | odontal therapy. However, prudence dictates extraction J of questionable teeth because periodontal treatment after irradiation may be limited to nonsurgical forms of 1 therapy. I lap surgery or extraction of teeth after radia- I

lion may lead to OUN. Management of ORN is often difficult and costly, involving progressive!) more aggressive treatment if bone does not respond to conservative therapy. Costly hyperbaric oxygen therapy is frequently required for complete resolution.

During radiation therapy, patients should receive weekly prophylaxis, oral hygiene instruc tion, and professionally applied fluoride treatments unless mucositis prevents such treatment. Patients should be instructed to brush daily with a 0.4% stannous or 1.0% sodium fluoride gel. Custom gel trays allow optimum fluoride application.*9 All remaining teeth should receive thorough debridement (scaling and root planing).

Post irradiation follow-up consists ol palliative treatment given as indicated. Viscous lidocaine may be prescribed for painful mucositis, and salivary substitutes may be given for xerostomia. Daily topical fluoride application and oral hygiene are the best means of preventing radiation caries in the long-term aspect. A long-term, 3-month recall interval is ideal.

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Responses

  • Mewael
    Can radiotheraphy cause periodotitus?
    5 years ago
  • kidane
    Can radiationcausepeperiodontitus?
    4 years ago
  • maija
    Does irradiation therapy cause peridontal disease?
    9 months ago

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