Dental problems are common after exposure of the head and neck to radiation therapy.
Long term effects on the oral cavity include:
- Reduced blood supply to the maxillary and mandibular bones.
- Reduced production and changes in the chemical composition of saliva.
- Changes in the bacteria that colonize the mouth.
It is advisable that patients receiving radiation therapy to the head and neck visit their dentist for a thorough oral examination several weeks prior to initiation of the treatment and be examined at a regular annual or semiannual basis throughout life. Getting regular dental cleaning by a dental hygienist or a dentist are also important.
Dental prophylaxis can reduce the risk of developing dental problems leading to bone necrosis. Special fluoride treatments may help to prevent dental problems, along with brushing, flossing, and having one's teeth cleaned regularly.
- Flossing each tooth and brushing with toothpaste after each meal.
- Brushing the tongue with a tongue brush or a soft bristled toothbrush once a day.
- Rinsing with a baking soda rinse daily. Baking soda helps neutralize the mouth. The rinse is made of one teaspoon of baking soda added to 12 oz. of water. The baking soda rinse can be used throughout the day.
- Using fluoride in fluoride carriers once a day. These preparation are commercially available and are also custom made by dentists. They are applied over the teeth for 10 minutes. One should not rinse, drink, or eat for 30 minutes after fluoride application.
Measures to reduce and prevent acid reflux include:
- Losing weight (in those who are overweight)
- Reducing stress and practicing relaxation techniques
- Avoiding foods that worsen symptoms (e.g., coffee, chocolate, alcohol, peppermint, and fatty foods
- Stopping smoking and passive exposure to smoke
- Eating small amounts of food several times a day rather than large meals
- Siting when eating and staying upright 30-60 minutes later
- Avoiding lying down for 2-3 hours after a meal
- Elevating the beds' head side by 6-8 inches (by putting blocks of wood under 2 legs of the bed or a wedge under the mattress) or by using pillows to elevate the upper portion of the body by at least about 45 degrees
- Taking a medication that reduces the production of stomach acids, as prescribed by one's physician
- When bending down, bending the knees rather than bending the upper body
Hyperbaric oxygen therapy
HBO is used to treat a wide range of medical conditions including: bubbles of air in the blood vessels (arterial gas embolism), decompression sickness, carbon monoxide poisoning, a wound that won't heal, a crush injury, gangrene, skin or bone infection causing tissue death (such as osteoradionecrosis), radiation injuries, burns, skin grafts or skin flaps at risk of tissue death, and severe anemia.
HBO can be used in patients with head and neck cancer for the treatment of osteoradionecrosis, refractory osteomyelitis, dental procedures (i.e., extractions), avert the risk of flap or graft failure, and necrotizing soft tissue and wound infections. Antibiotics are administered in conjunction with HBO to those with infections.
Patients should inform their dentists about their radiation therapy prior to extraction or dental surgery. Osteonecrosis may be prevented by administration of a series of HBO therapy before and after these procedures. This is recommended if the involved tooth is in an area that has been exposed to a high dose of radiation. Consulting the radiation oncologist who delivered the radiation treatment can be helpful in determining the extent of prior exposure.
HBO therapy is generally safe, and complications are rare. These can include: temporary nearsightedness (myopia), middle ear and inner ear injuries (including leaking fluid and eardrum rupture due to increased air pressure), organ damage caused by air pressure changes (barotrauma), and seizures as a result of oxygen toxicity.
HBO therapy can be performed as outpatient procedure and does not require hospitalization. Hospitalized patients may need to be transported to and from the HBO therapy site if it is an outside facility.
Patients with claustrophobia can be pretreated with ant-anxiety medications.
- Patients should wear cotton cloth and gown.
- Avoiding the use of battery operated devices inside the chamber. Medical devices (i.e., pacemaker, defibrillator) are allowed after they have been tested.
- Avoiding cosmetics.
- No newspaper, tobacco products or matches are allowed.
- Grounding the patient with a wire.
To be effective, HBO therapy requires more than one session. The number of sessions required depends on the medical condition. Some conditions, such as carbon monoxide poisoning, can be treated in as few as three visits. Others, such as osteoradionecrosis, and non-healing wounds, may require 20 to 30 treatments. Those who require dental extraction are often 20 treatments prior to the procedure and 10 following it.