Osteoradionecrosis: its prevention
O'Sullivan, B.P.; Oatis, G.W.; Grisius, R.J.
Clinical Preventive Dentistry 4(4): 8-12
1982
ISSN/ISBN: 0163-9633 PMID: 6759005 Document Number: 195748
Prevention of osteoradionecrosis has been stressed due to the absence of a predictable method of treatment. A preradiation consultation with the radiotherapist should inform the dentist as to the mode of delivery, dosage and field of exposure. These factors will ultimately determine whether a conservative or aggressive approach to dental treatment is instituted. Preradiation classification and treatment guidelines are provided, based on the degree of oral disease present. Definitive treatment modalities, especially oral surgical procedures, should be instituted immediately so as not to compromise control of the tumor by delaying the initiation of radiotherapy. Preradiation extractions, when necessary, are accompanied by a radical alveolectomy to insure both a smooth ridge and a primary closure. Postradiation extractions, in contrast, warrant a more conservative surgical approach. Atraumatic surgical technique with the intent to preserve the periosteum reduces the occurrence of osteoradionecrosis. The decision to provide dentures for postradiation patients depends on the extent of healing prior to the onset of radiotherapy. Patients who were edentulous and completely healed prior to therapy have a minimal risk of osteoradionecrosis and may receive dentures within 6 mo. When multiple extractions with radical alveolectomies of the mandible are required prior to therapy, a substantially longer time may be necessary for adequate healing. The importance of follow-up after irradiation is paramount. A recall program must be instituted on a 3-mo. basis with the intent of insuring plaque control maintenance and early detection of pathology.