ORAL MANAGEMENT

OF IRRADIATED HEAD
AND NECK CANCER
PATIENTS
Leanne Sykes
Medical University of South Africa
 Ionizing
radiation

Tumour eradication
or palliative therapy

Transient / permanent
tissue damage
RADIOTHERAPY
Poor oral hygiene Local trauma

AGGRAVATING
FACTORS

Infection Debilitation
Region Total amount
of radiation
irradiated
absorbed

MORBIDITY
Patient’s individual
biologic response
EFFECTS MAY INCLUDE:
Mucositis
Xerostomia
Altered oral flora
Taste loss
Sensitivity – tooth, mucosa
Osteoradionecrosis (ORN)
Post radiation caries (PRC)
Periodontal disease
Trismus
EFFECTS MAY INCLUDE:

Mucositis
Xerostomia
Altered oral flora
Taste loss
Sensitivity – tooth, mucosa
Osteoradionecrosis (ORN)
Post radiation caries (PRC)
Periodontal disease
Trismus
EFFECTS MAY INCLUDE:
Mucositis
Xerostomia
Altered oral flora
Taste loss
Sensitivity – tooth, mucosa
Osteoradionecrosis (ORN)
Post radiation caries (PRC)
Periodontal disease
Trismus
 Taste Buffering

Mucosal repair Digestion

FUNCTIONS OF SALIVA

Tooth integrity Protection

Antimicrobial
Acinar cell loss + Connective tissue
replacement

Lymphocyte and plasma

cell infiltration

Damage to the blood supply

to the glands

XEROSTOMIA
-scant
-thick
-ropy
-viscous
EFFECTS MAY INCLUDE:
Mucositis
Xerostomia
Altered oral flora
Taste loss
Sensitivity – tooth, mucosa
Osteoradionecrosis (ORN)
Post radiation caries (PRC)
Periodontal disease
Trismus
 CA DA
ND I

IC FL ORA
I OG E N
CAR
EFFECTS MAY INCLUDE:
Mucositis
Xerostomia
Altered oral flora
Taste loss
Sensitivity – tooth, mucosa
Osteoradionecrosis (ORN)
Post radiation caries (PRC)
Periodontal disease
Trismus
Zinc Sulphate
EFFECTS MAY INCLUDE:
Mucositis
Xerostomia
Altered oral flora
Taste loss
Sensitivity – tooth,
mucosa
Osteoradionecrosis (ORN)
Post radiation caries (PRC)
Periodontal disease
Trismus
 Cold Heat

Acids PAIN Alcohol

Tobacco Spicy foods

EFFECTS MAY INCLUDE:
Mucositis
Xerostomia
Altered oral flora
Taste loss
Sensitivity – tooth, mucosa
Osteoradionecrosis
(ORN)
Post radiation caries (PRC)
Periodontal disease
Trismus
EFFECTS MAY INCLUDE:
Mucositis
Xerostomia
Altered oral flora
Taste loss
Sensitivity – tooth, mucosa
Osteoradionecrosis (ORN)
Post radiation caries
(PRC)
Periodontal disease
Trismus
 CERVICALLY

CUSP TIPS
NEUTRAL
EFFECTS MAY INCLUDE:
Mucositis
Xerostomia
Altered oral flora
Taste loss
Sensitivity – tooth, mucosa
Osteoradionecrosis (ORN)
Post radiation caries (PRC)
Periodontal disease
Trismus
EFFECTS MAY INCLUDE:
Mucositis
Xerostomia
Altered oral flora
Taste loss
Sensitivity – tooth, mucosa
Osteoradionecrosis (ORN)
Post radiation caries (PRC)
Periodontal disease
Trismus
PREVENTIVE STRATEGIES

Oral hygiene instruction and

treatment
PREVENTIVE STRATEGIES
Oral hygiene instruction and treatment

Impressions for fluoride trays

PREVENTIVE STRATEGIES
Oral hygiene instruction and treatment
Impressions for fluoride trays

Necessary extractions
Restorative treatment
PREVENTIVE STRATEGIES
Oral hygiene instruction and treatment
Impressions for fluoride trays
Necessary extractions
Restorative treatment

Retention of teeth for future

prostheses
 PREVENTIVE STRATEGIES
Oral hygiene instruction and treatment

Impressions for fluoride trays

Necessary extractions

Restorative treatment

Retention of teeth for future prostheses

Patient counselling
 PREVENTIVE STRATEGIES
Oral hygiene instruction and treatment

Impressions for fluoride trays

Necessary extractions

Restorative treatment

Retention of teeth for future prostheses

Patient counseling

Regular recall visits

THE KEY TO SUCCESS
=
MULTIDISCIPLINARY

TEAMWORK