Radiation-induced oral side effects in head and neck cancer: a scoping review and interdisciplinary recommendations

Head and neck cancer remains a major global health challenge, with radiotherapy representing a central component of curative and palliative treatment. Despite advances in precision techniques, high-dose irradiation unavoidably affects adjacent oral structures, leading to a broad spectrum of side effects. These include dental caries, periodontitis, xerostomia, mucositis, candidiasis, trismus, dysphagia, and osteoradionecrosis—each with potential for chronic morbidity and diminished quality of life. This scoping review aims to summarize current evidence on oral side effects associated with head and neck radiotherapy, raise interdisciplinary awareness and propose a dental care model ensuring individualized therapies while focusing on prevention. Radiation-induced oral effects are common, multifactorial, and often long-lasting. Caries and periodontitis are largely driven by hyposalivation and mucosal compromise, while trismus reflects dose-dependent impairment of the masticatory apparatus. Osteoradionecrosis, though less frequent, carries severe clinical consequences. A systematic literature search was conducted using PubMed for articles published between 1999 and November 2025. The search strategy combined the terms “head and neck cancer”, “radiotherapy” with the side effects mentioned above. Studies were considered eligible if they examined oral side effects resulting from radiotherapy in patients with head and neck cancer, in total, 151 studies were included into the review. We describe the epidemiology, underlying mechanisms, and clinical manifestations of common sequelae and provide a structured overview of preventive and therapeutic strategies. The understanding, early identification and management of radiation-induced oral complications are essential to preserve function, maintain quality of life, and improve long-term outcomes for head and neck cancer patients.