Oral and dental complications and management in head and neck cancer patients: An umbrella review

OBJECTIVES: To synthesise evidence on oral and dental side-effects experienced by head and neck cancer (HNC) patients, assess the strength and quality of existing systematic reviews, evaluate the evidence for prevention and management interventions and identify key gaps to inform future research. DATA: Systematic reviews (with/without meta-analysis) published from 2015 onwards involving adults with HNC reporting oral/dental complications and/or interventions were included. SOURCES: MEDLINE (OVID), Embase, Cochrane Database of Systematic Reviews and Scopus were searched (19 June 2025). Two reviewers screened and extracted data independently. STUDY SELECTION: An umbrella review (PROSPERO CRD420251063188) was conducted following JBI/Cochrane guidance and reported in line with PRISMA 2020. Methodological quality was assessed using AMSTAR-2 and primary-study overlap quantified using corrected-covered-area (CCA). Owing to heterogeneity, findings were synthesised narratively by domain. CONCLUSIONS: A total of 131 systematic reviews were included, with most rated as low or critically low confidence. Oral mucositis was the most frequently reported complication, followed by xerostomia, dysphagia, trismus, dental caries, and dysgeusia; osteoradionecrosis was less common. Preventive and therapeutic interventions are widely studied but largely supported by low-quality evidence. Photobiomodulation was associated with reduced oral mucositis, while intensity-modulated radiotherapy was associated with reduced xerostomia and mandibular osteoradionecrosis. Overall, the evidence base is fragmented and of low confidence. Standardised outcome measures and high-quality prospective studies are needed to strengthen the evidence base and improve survivorship care. CLINICAL SIGNIFICANCE: Head and neck cancer patients experience a high burden of oral complications, yet dental management strategies are supported by limited high-quality evidence. This review highlights key areas of uncertainty and reinforces the need for multidisciplinary, evidence-based care, while identifying priorities for research to improve long-term oral health and quality of life.