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Pre-irradiation Dental Evaluation

last modified on: Sat, 05/13/2017 - 17:05

Pre-Irradiation Dental Evaluation

  1. RATIONALE
    1. Attempt the establishment of a lifelong prognosis for those teeth to potentially be encompassed by the radiation portals.
      1. Recommend the preradiotherapeutic extraction of those teeth whose lifelong prognoses are questionable, as the extraction of these teeth following the delivery of radiotherapy (XRT) could place the patient at risk for osteoradionecrosis (ORN).
      2. Advise the patient respecting the import of consulting his or her radiation oncologist before initiating any bone exposing oral surgical procedures following the completion of XRT. Such a consultation would apprise the practitioner of the radiation dosage to the proposed surgical site and provide an assessment of the surgery's potential for inducing ORN. Dentoalveolar structures that have received greater than 50 Gy of radiation are at substantial risk of developing ORN.
    2. Advise the patient regarding meticulous oral hygiene, as teeth that remain following the delivery of head and neck radiotherapy are usually at risk for dental caries secondary to xerostomia.
    3. Advise the patient respecting prosthodontic options following the cessation of XRT.
  2. CLINICAL REGIMEN
    1. Radiographic Evaluation
      1. Intraoral radiography
        1. Provides greatest image resolution for dental and periodontal evaluation.
        2. Indications
          1. Full mouth intraoral radiographic series (FMX) when portions or all of the dentition is, upon presentation, considered healthy enough to potentially retain
          2. Selected intraoral radiographs to bolster panoramic radiographic evidence of maxillary or mandibular tumoral invasion
          3. Occlusal radiographs provide images of buccal or lingual cortices that can identify tumoral invasion not necessarily detectable upon panoramic or conventional intraoral radiography.