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Late Effects of Radiation Treatment on Oral Health for Patients with Head and Neck Cancer

From the Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, and the Department of Otolaryngology and Head and Neck Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL; and the Department of Medicine, Pain and Symptom Management Program, and Head and Neck Research Team, Vanderbilt University Medical Center, Nashville, TN

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Joel B. Epstein, DMD, MSD, FRCD(C), FDS, RCS(Edin), Professor, the Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois at Chicago, 601 S Morgan St, 556 DENT, Chicago, IL 60607; e-mail: jepstein{at}uic.edu

Overview: Head and neck cancer and its treatment result in numerous oral health outcomes that require the ongoing attention of health care providers. Although many of the acute oral heath issues are clearly described, the late effects of treatment on oral health are not well understood. There is a paucity of data regarding the frequency and severity of late oral health effects and their management. Furthermore, the potential negative impact of late oral health problems on symptom burden, oral function, and overall health is largely underappreciated. As the number of survivors of head and neck cancer increase, there has been a surge of interest in late treatment effects. In the past, this has focused on osteonecrosis. It is becoming increasingly recognized that oral health issues are one of the frequent and bothersome late effects. Some of the chronic complications increase the risk and may be a trigger of osteonecrosis. Many of the late effect oral health problems can be addressed through aggressive preventive and therapeutic measures. Clinicians play an important role in the assessment and management of oral health issues, thus, they must be familiar with appropriate supportive measures. This article reviews the late effects of head and neck cancer therapy on oral health and the increase in the risk of osteonecrosis.