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Head and Neck Cancer

Extraction of Tooth

02/18/2009

Question:

Was treated for a T4 N2 carcinoma of the nasopharynx to a dose of 70Gy in 33 fractions which was completed in July 2007. One of molars in the upper jaw has decayed badly all the way down to the root and was advised by three dentists that it is not safe to extract. However, I got a fourth opinion and together with my oncologist and haematologist, they all agreed that it is quite safe but I am in a bit of a doubt because sad to say I have lost some confidence in the medical fraternity in my country. I need to act swifty on this matter.....please, please advised me.. I am so at a loss!!!!!! Thank you.

Answer:

The concern with dental extractions in people who have had radiation therapy for head and neck cancers is the development of osteoradionecrosis. Necrosis is pathologic death of one or more cells, or of a portion of tissue or organ, resulting from irreversible damage. Radionecrosis is necrosis due to radiation. If one is speaking of osteoradionecrosis, it’s bone death due to radiation.

When patients undergo radiation therapy for head and neck cancer, because their salivary glands are exposed to this radiation, their saliva is changed. Saliva not only helps moisten food, and begin the digestive process of the food, it also helps protect the teeth from dental caries. Unfortunately, when radiation changes the saliva, it’s not as effective at protecting the teeth from these dental caries.

The dental issues does need to be addressed.  When dealing with mandibular teeth hyperbaric oxigen therapy is often recommended prior to extraction. The risk of radionecrosis of the maxilla is minimal and I believe the tooth can be safely removed without hyperbaric oxygen.

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Response by:

Cheryl  Koliha-Brandt, MSN, RN, CNS, CORLN Cheryl Koliha-Brandt, MSN, RN, CNS, CORLN
Clinical Nurse Specialist and Instructor of
Head and Neck Surgery and Oncology 
Frances Payne Bolton School of Nursing
Case Western Reserve University

Pierre  Lavertu, MD, FRCS(C), FACS Pierre Lavertu, MD, FRCS(C), FACS
Professor of Otolaryngology-Head and Neck Surgery
School of Medicine
Case Western Reserve University