Dental Assessment Clinic - For patients receiving head and neck radiotherapy

Why do I need to see a dentist?

All patients who receive radiotherapy as part of their cancer treatment will have a pre-treatment dental assessment. You will also have an X-ray of your mouth. We will assess your mouth and teeth to identify and remove any dental decay or infection. This will help to reduce any problems you may have in your mouth during or after your cancer treatment.

What will happen if my teeth and gums are not healthy when radiotherapy begins?

Radiotherapy causes changes to the bone making it less able to heal itself and puts you at risk of a condition called osteoradionecrosis. This is a condition where the jawbone can die in places which can be painful and is hard to treat.

If a dental extraction is needed after head and neck radiotherapy treatment, the risk of osteoradionecrosis is higher. There is also a higher risk if your mouth and teeth are not as healthy as they could be.

To reduce the chance of developing this condition it is important not to have any teeth taken out while you are having radiotherapy. Tooth sockets will not heal well during treatment and osteoradionecrosis could develop. Any poor quality teeth should be taken out before your radiotherapy treatment starts.

The dental team will assess your mouth and may recommend simple fillings or the smoothing of any sharp teeth or dentures. This will need to be done by your own dentist. You will also be referred to a dental hygienist to make sure your gums are as healthy as possible.

How is it decided which teeth are to be taken out?

The consultant dentist you see in the clinic will decide which teeth will need to be taken out. Their decision will be based on which area of your mouth/throat/neck or face will receive radiotherapy. Sometimes only one side of your face and neck will receive radiotherapy; for some patients it can be to both sides.

If your teeth are very decayed, deeply filled or loose then these teeth are most likely to be recommended for removal.

The consultant dentist assessing your teeth will explain which teeth are recommended to be removed and involve you in any decision about your care and treatment.

Consent for treatment

If you decide to go ahead with treatment you will be asked to sign a consent form. By signing this form, you are agreeing to have the treatment and you understand what it involves.

What happens during my dental extractions?

Most teeth are taken out using local anaesthetic (while you are awake). The surgeon will inject some anaesthetic into your gums to numb the area.

What if I am very anxious about dental treatment?

If you are worried that you may not be able to cope with having your teeth removed under local anaesthetic, please tell us at your assessment appointment. We will be able to arrange treatment using sedation (medication to relax you) or a general anaesthetic (where you will be asleep for the procedure).

However, because these treatments can be more difficult to arrange, it could delay the start of your radiotherapy.

After you have had your teeth taken out

You can usually go straight home. Your surgeon will give you after care instructions.

Follow up appointment

You will be seen in the Dental Assessment Clinic again 4 and 6 months after you have completed your radiotherapy treatment. This will be for a dental and general oral check-up. An appointment will be sent to you in the post.

Your dental treatment plan

• Pre-treatment dental assessment.
• An appointment with a dental hygienist.
• Teeth removed as necessary.
• You will have any fillings or other treatment recommended. This treatment will need to be completed by your own dentist.

After the completion of your radiotherapy treatment

• A review by a dental consultant is not always necessary.
• You will be discharged to your own dentist or you will need to find a dentist for your future dental care.

When can I have dentures made if needed?

Having dentures made is usually delayed for 6 months after you have completed your radiotherapy treatment. This is because it is really important that your gums have healed properly following your radiotherapy treatment. Your own dentist will be required to make any dentures needed.

If dentures are made too early, they may cause pain and damage to your gums and in rare cases even osteoradionecrosis.

What if I need to have teeth taken out in the future?

You must tell your own dentist that you have had radiotherapy to your head and neck. If you change your dentist, remember to tell them too. Normal dental treatment can be carried out but every attempt must be made to prevent more teeth being taken out in the future.

If you do need any dental extractions, you must be referred to the Oral and Maxillofacial Department by your own dentist. This is because any dental extractions will need to be performed by a specialist due to the life-long risk of osteoradionecrosis in light of previously having head and neck radiotherapy

Contact information

Oral and Maxillofacial Surgery

Tel: 0300 422 8175

Monday to Friday, 9:00am to 5:00pm

Head and Neck Macmillan Clinical Nurse Specialist

Tel: 0300 422 6785

Monday to Friday, 9:00am to 4:00pm

Further information

Mouth Cancer Foundation

Website: www.mouthcancerfoundation.org