Radiotherapy and oral and dental health

In order to protect the oral and dental health of the patient during and after radiotherapy, more care should be taken than a normal oral care.

After radiotherapy; Taste disturbance, mucositis, stomatitis, dermatitis, xerostomia, radiation caries, trismus, periodontal problems, decreased flexibility of tissues around the mouth, changes in bone structure and osteoradionecrosis can be seen. All these negatively affect the patient’s quality of life.

Loss of sweet, salty, bitter and acidic flavors occurs within the first week of therapy. Taste disturbance partially resolves up to 20-60 days after completion of radiotherapy.

The severity and duration of mucositis, i.e. mucous membrane (tissue layer) inflammation, varies according to the applied dose, alcohol-cigarette use. It starts in the 2nd week of the treatment, but disappears 2-3 weeks after the treatment ends. In its treatment, it is aimed to ensure the comfort of the patient, reduce tissue damage, and control superinfections. With the application of salt water and soda mouthwash 3-5 times a day, the pain is relieved and the mucosa is kept moist. Infections are tried to be prevented by paying attention to daily oral hygiene.

Infections occur as a result of decreased salivary flow, that is, dry mouth, and their severity may increase due to not paying attention to oral hygiene, alcohol-cigarette use, and prosthesis irritation. Topical antifungals (such as nystanin solution, clotrimazole pills) can be used in its treatment.

Spasm may develop when the temporomandibular joint and masticatory muscles are exposed to radiation. Depending on this, trismus, that is, limitation in opening the mouth, occurs. Trismus may occur during radiotherapy or within 6 months following treatment. In order to be protected from trismus, mouth opening-closing exercises should be performed continuously and should be continued after recovery.

Xerostomia, that is, dry mouth, is the most common adverse event in patients exposed to radiation. It occurs because the salivary glands remain within the radiation field. Patients mostly complain of a burning sensation and that they cannot swallow food easily. They have difficulty using their prostheses and the oral mucosa is more susceptible to infection and trauma-related ulcerations. Water, glycerin and artificial saliva preparations are often used to replace the missing saliva.

Radiation does not directly cause dental caries. However, due to xerostomia, decreased quality of saliva, decreased buffering capacity, and the inability to clean the waste mechanically due to the decrease in salivary flow, the formation of caries increases. Radiation caries usually start and progress from the cervical surfaces of the teeth, that is, close to the gums.

Osteoradionecrosis (ORN) is the most serious complication of radiotherapy. It is especially caused by tooth extractions performed immediately after radiation therapy. Tooth extractions should be done at least 3-4 weeks before the start of the treatment and it should be ensured that there is full recovery before the treatment and that there is no exposed bone tissue. In addition, alcohol-cigarette use, poor oral hygiene, and malnutrition can be counted among the risk factors. When ORN develops, bone tissue with necrosis should be removed, antimicrobial agents can be used to accelerate healing.

Oral and Dental Care Before Radiotherapy: By cleaning the tartar, hard and soft residues should be removed. Oral hygiene should be ensured and soft tissues should be restored. Filling or root canal treatment of decayed teeth should be done, any rough and sharp surfaces should be smoothed out. Teeth with deep caries, periodontally unhealthy, thought to be unsuccessful in terms of endodontic treatment, and suspicious condition should be extracted at least 3 weeks before radiotherapy.

Oral Care During Radiotherapy: During treatment, patients should be checked every week. The mouth should be gargled frequently with soda and salt water. To reduce gingival inflammation, mouthwashes with chlorhexidine should be used 3-4 times a day. Artificial saliva can be used to lubricate the mucosa and prevent trauma. Trismus preventive exercises should not be neglected.

Oral Care After Radiotherapy: Patients should be checked once or twice in the first month following radiation therapy. Then they can be called for control every 3-4 months. The aim is to prevent radiation caries and periodontal diseases, to reduce the risk factors involved in the development of ORN, and to manage chronic effects such as xerostomia. Teeth should be checked for calculus and caries. 6 months – 1 year should be waited for tooth extractions and final dentures.

As a result of radiotherapy, the quality of life of patients is adversely affected. In order to protect the oral and dental health of the patients, harmony between the dentist, the patient’s family and the patient is important.