Oncology

Dental Management of Patients with Radiotherapy — head & neck region

Confirm radiation dose (Gy) to the jaws

Osteoradionecrosis risk rises with dose to the jaws; a dose >60 Gy is high risk. Extractions in irradiated bone are hazardous.

Emergency vs routine management

If EMERGENCY — what to do

• Avoid extraction in the irradiated field where possible — prefer root canal treatment or decoronation.Ref: Peterson DE et al. Prevention and Management of Dental Disease in Patients Undergoing Head & Neck Radiation — ISOO/MASCC/ASCO Guideline. J Clin Oncol 2024
• If extraction is unavoidable (especially > 50–60 Gy): atraumatic technique, primary closure, antibiotics, and referral to oral & maxillofacial surgery.Ref: Peterson DE et al. Prevention and Management of Dental Disease in Patients Undergoing Head & Neck Radiation — ISOO/MASCC/ASCO Guideline. J Clin Oncol 2024

If ROUTINE — what to do

• Before radiotherapy: remove poor-prognosis teeth ≥ 2 weeks before treatment starts.Ref: Peterson DE et al. Prevention and Management of Dental Disease in Patients Undergoing Head & Neck Radiation — ISOO/MASCC/ASCO Guideline. J Clin Oncol 2024
• After radiotherapy: daily high-fluoride (5,000 ppm) or fluoride trays, 3–4-monthly recall, xerostomia and trismus management.Ref: Peterson DE et al. Prevention and Management of Dental Disease in Patients Undergoing Head & Neck Radiation — ISOO/MASCC/ASCO Guideline. J Clin Oncol 2024

Clinical precautions

• Confirm dose (Gy) and field to the jaws
• Refer for specialist assessment before extraction

Information & tests to request

• Radiation dose to jaws (Gy)

At a glance by procedure

Initial assessment before lab results or timing details are entered.

Procedure	Initial assessment
Examination / radiographs	ROUTINE Radiation history — non-bony procedure
Supragingival scaling / polish	MODIFY / CAUTION Radiation history — non-bony procedure
Deep scaling / subgingival RSD (subgingival calculus)	MODIFY / CAUTION Radiation history — non-bony procedure
Root canal treatment	MODIFY / CAUTION Radiation history — non-bony procedure
Simple extraction (1–3 teeth)	MODIFY / CAUTION Confirm radiation dose (Gy) to the jaws
Surgical / bony extraction	MODIFY / CAUTION Confirm radiation dose (Gy) to the jaws
Implant placement	MODIFY / CAUTION Confirm radiation dose (Gy) to the jaws

Get a patient-specific decision in seconds

Combine all conditions, medications, lab results and the planned procedure — with anaesthetic dose calculation, lab requests and a referral letter PDF.

References

Head & neck radiotherapy — osteoradionecrosis (ORN) prevention
Peterson DE et al. Prevention and Management of Dental Disease in Patients Undergoing Head & Neck Radiation — ISOO/MASCC/ASCO Guideline. J Clin Oncol 2024

This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.