Myth or Truth: When is extraction recommended for a patient who had head and neck radiation?
Drs. Debbie Saunders and Joel Epstein dispel the myth of time required to extract a tooth in a patient who has undergone head and neck radiation.
Dr. Debbie Saunders is a Dentist and Medical Director of the Dental Oncology Program, Health Science North, in the North East Cancer Center. She is also Assistant Professor in the Norther Ontario School of Medicine.
Dr. Joel Epstein is Professor and Medical Director Cancer dentistry at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Health System in Los Angeles and the Division of Otolaryngology and Head and Neck Surgery in City of Hope.
Highlights
Many health professionals wonder if it is safe to remove teeth after a patient has had radiation treatment. While it is always better to extract the tooth prior to radiation treatment, sometimes the situation is not always predictable. In situations where teeth do need to be removed after radiation, it is important to communicate directly with the cancer centre and radiologist to find out what the dose of radiation was and if the tooth was involved in the radiation field.
Radiation effects increase over time based on bone physiology as the cellular elements and vascular supplies decrease over time as the radiation effect matures in bone. This results in delayed or non-healing.
Watch the video conversation
Patients that have received 60-70Gy radiation therapy for head & neck cancer do, however, occasionally need extraction of teeth in the previous radiation field (long-term failure of endodontically treated teeth, trauma, etc.). Do you still follow the Marx protocol for single tooth extraction in patients without hyperbaric oxygen?
I thought this presentation was very well done, I have had to treat a patient who presented with the need to have extractions after significant radiation therapy, even with the best care our specialty team provided, the oncologist, the radiation oncologist and the oral surgeons, following the Marx protocol he developed a non responsive osteoradionecrosis. He lived with this condition for a couple of years. He understood the risks, he had wonderful supportive care and died from a heart attack ultimately.
I wish I had known this patient before his radiation therapy and knew then what I know now! I feel that with a presentation like this I would be better able to help manage another patient in the future. Thank you so much for this extremely relevant and expert presentation.