Why is Dental Treatment Necessary before Starting Radiation Therapy?

Why Dental Treatment is Required before starting radiation therapy as a part of Oral Cancer Treatment at The Maxfac Clinic

Oral cancer has claimed many lives and drastically decreased the quality of life of survivors not only in India, but the world over. The most important reason for the increasing number of oral cancer cases in the recent years is increasing use of tobacco and tobacco based products. In the Asian countries arecanut or supari or betelnut is also a major contributing factor. Other causative factors are heavy alcohol consumption, excess sun exposure on lips, Human Papilloma Virus infection and genetics. Oral cancer can affect one or more sites of the mouth, such as lips, tongue, gums, bone, palate, floor of mouth etc. Based on the site and extent of disease, it needs to be staged. The staging ultimately decides in the line of treatment. For better prognosis it is extremely important to have an early diagnosis, prompt treatment and comprehensive rehabilitation.

Mouth cancer treatment includes surgical management, Chemotherapy and Radiation therapy. For majority of the oral cancer sites surgery is the first line of treatment. Based on the staging of the disease chemotherapy and/or radiation therapy may be added to the treatment regime.

Radiation therapy makes use of specific radiation that is directed towards the cancer bed so as to kill and inactivate the cells. Along with affecting the cancer cells, the radiation also has effects on normal cells in that area. Radiation induced effects are mainly targeted towards oral mucosa, salivary glands, bone, teeth and muscles of mouth and face.

Following are the immediate side effects to the surrounding normal structures:
• Oropharyngeal mucositis – This means inflammation and burning of the mouth and throat tissues that occurs due to radiation and reduced immunity and/or fungal infection

• Reduced salivation – This leads to dryness of mouth and difficulty in swallowing

• Burning mouth – This is due to inflammation and damage to nerve endings

• Dysguesia or Alteration of taste – This is due to damage to the taste buds

• Infection (bacterial and fungal) due to reduced immunity

• Pain in gums

Apart from the above immediate side effects, certain delayed effects of radiation therapy that may be seen are as follows:
• Trismus (reduced mouth opening) and fibrosis of the tissues inside the mouth

• Malnutrition due to insufficient mouth opening and reduced saliva in mouth.

• Osteoradionecrosis of jaw bone

• Dental caries- high risk of dental decay especially near the gum area

• Xerostemia or Dry mouth that affects chewing, speech and swallowing.

These severity of these side effects can gradually reduce with time after completion of radiotherapy, but it does cause a great deal of discomfort to the patient. Surgical removal of the part of the mouth that’s affected by cancer does make functions like chewing, swallowing and speech more difficult. The remaining healthy oral tissues need to be maintained so that these functions can be as comfortable as possible after treatment. Hence, it is very important to pay special attention towards prevention and management of these radiation induced side effects.

The Maxfac Clinic not only provides oral cancer treatment in Mumbai, but we also offer complete dental treatment for patients scheduled to undergo Radiation therapy so as to reduce the severity of the side effects. Radiation therapy for oral cavity cancers is usually approximately 4- 6 weeks after surgery, once the healing of the surgical wound takes place. During this time a thorough assessment of the oral cavity has to be done so as to provide a comprehensive dental treatment such as tooth extraction, dental scaling, management of carious teeth either by fillings or root canal treatment. Our Pre-radiotherapy dental evaluation and treatment includes and is not limited to:
1. Detailed consultation and identification of existing dental issues and potential issues
2. Counsel patient about short- and long-term complications of radiotherapy

3. Adequate dental radiographs

4. Identification of teeth with significant risk of infection that requires immediate dental treatment

5. Dental extraction if needed (Extraction should be done at least 10 to 15 days before starting the radiation therapy to avoid risk of osteoradionecrosis)

6. Professional dental and gum cleaning

7. Filling of all teeth with cavities

8. Assessment of existing dental prosthesis for any sharp edges

9. Fluoride application to strengthen the remaining teeth against decay

10. Supportive care for oral mucositis

11. Treatment of fungal infections

12. Management of xerostomia (dry mouth)

13. Preventive measure for post radiation osteonecrosis

14. Dietary guidance

15. Guidance regarding the use of salivary substitutes

To understand more about mouth cancer treatment or Dental treatment before Radiation therapy and post treatment rehabilitation options, feel free to contact The Maxfac Clinic on +91 8879745345. We are a super-speciality clinic providing Oral Cancer treatment in Mumbai.