Ovidental Editorial Team
hola@ovidentalgo.com
Radiotherapy in the head and neck region is a common treatment modality for malignant tumors.
However, this approach often leads to significant oral complications, especially during invasive procedures such as dental extractions.
One of the most concerning sequelae is osteoradionecrosis (ORN) of the jaws, a condition characterized by bone necrosis due to decreased vascularity and the compromised reparative capacity of irradiated bone.
Risks Associated with Post-Radiotherapy Extractions
Dental extractions after radiotherapy significantly increase the risk of ORN.
This risk is particularly high when extractions are performed on bone exposed to high doses of radiation.
As a result, dentists must carefully evaluate the need for surgical interventions in irradiated patients.
Evidence-Based Recommendations
1. Pre-Radiotherapy Assessment
Patients should undergo a comprehensive dental evaluation before starting radiotherapy. Extraction of teeth with poor prognosis should be considered prior to treatment to minimize post-radiotherapy complications.
2. Precautions for Necessary Post-Radiotherapy Extractions
- Meticulous Planning
If an extraction is unavoidable, the procedure must be carefully planned, considering the radiation dose and anatomical location.
- Hyperbaric Oxygen Therapy (HBOT)
Studies suggest that HBOT before and after extraction can reduce the risk of ORN by improving oxygenation and vascularization in irradiated bone.
- Antibiotic Coverage
Prophylactic antibiotics may help prevent infections that could complicate healing.
3. Alternatives to Extraction
Whenever possible, conservative treatments such as root canal therapy should be considered to avoid invasive surgical procedures in irradiated areas.
4. Follow-Up and Maintenance
Regular oral health monitoring for irradiated patients is crucial. Routine dental visits allow for early detection of complications and the implementation of preventive measures.
Conclusion
Dental extractions in patients who have undergone radiotherapy for head and neck cancers pose significant clinical challenges due to the risk of osteoradionecrosis.
Interdisciplinary planning, careful evaluation, and the consideration of alternative treatments are essential to minimize risks and ensure optimal patient care.
REFERENCES
