Modern Radiation Therapy for Head and Neck Cancer and the Management of Radiation-Induced Oral Complications

Background: The management of head and neck cancers is a unique crossroads between the dental and oncology disciplines. In the following manuscript, a summary of the modern advances in radiation treatment of head and neck cancers as well as a brief overview of some of the most common adverse effects will be reviewed with special emphasis on osteoradionecrosis. Types of Studies Reviewed: We reviewed the literature regarding major dental events after head and neck radiotherapy, which include 4 major categories including: 1) osteoradionecrosis, 2) gingival recession, 3) caries, extractions, tooth loss and 4) oral mucositis. Results: We summarized herein the literature behind the pathophysiology, risk factors and management options for major dental events after head and neck radiotherapy. We also have organized the major guidelines published for dental management before, during and after head and neck radiotherapy. Practical Implication: The cooperation between dentistry and oncology is paramount considering the advancements regarding overall survival and outcomes in cancer patients. Patients are expected to deal with the sequalae of the long-term, post-treatment effects of radiation therapy. Younger, healthier individuals are being diagnosed with head and neck cancers given the rise of HPV infections, which portends longer survival and the greater need to improve long-term dental health in this group. We hope that this review will be a resource to dental providers to help provide excellent care for head and neck cancer radiotherapy patients.