Dental considerations for head and neck cancer: A clinical review

Anti-cancer management of head and neck cancers and oral microbiome—what can we clinically obtain?

“…It is recommended to provide an appropriate dental care and treatment (such as elimination of oral infections and extractions of teeth with poor prognosis) before the introduction of radiotherapy to avoid, among others, osteoradionecrosis ( Abed et al., 2020 ). The definition of osteoradionecrosis is not completely provided, but four of its stages are listed based on the Lyons and Bernnan classification (stage 1: <2.5-cm length and asymptomatic exposed bone; stage 2: >2.5-cm length and asymptomatic exposed bone with pathological fracture and/or inferior alveolar nerve canal involvement; stage 3: >2.5-cm length and symptomatic exposed bone, however, with no other features despite medical treatment; stage 4: >2.5-cm length and symptomatic exposed bone with pathological fracture and/or inferior alveolar nerve canal and orocutaneous fistula) ( Abed, 2023 ). Despite the fact that the incidence of osteoradionecrosis decreased during the last years, it is still an aggressive late complication ( Kubota et al., 2021 ).…”

“…The abundance of some microbes was detected in case of osteoradionecrosis, thus suggesting the link between it and the microbiome ( Li et al., 2023 ). Dental care is also important in the post-radiation period including regular radiographs, relief of dry mouth, usage of high-fluoride toothpaste, and oral rehabilitation ( Abed, 2023 ). Reduction of saliva contributes to the development of periodontitis due to environmental alterations regarding also microbiome changes ( Sroussi et al., 2017 ).…”