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late effects of radiation on the mouth

Late Effects of Radiation Treatment in Head and Neck Cancer Survivors

By Jeffrey W. Cash, DDS

Survivors of head and neck cancer endure an exceedingly difficult journey.  Late effects of radiation treatment become apparent years after they have been cured.  As a dentist who has worked with patients faced with this life changing diagnosis, I wanted to try and summarize some of issues I have heard about from those under my care and from health care providers.

What Now?

A common phrase I hear from survivors is that radiation is the “gift that keeps on giving.”  Some say this to me in a humorous manner, but there is always a tone of sarcasm.  The goal of radiation is to stop and cure the cancer, but those receiving it move forward with permanent side effects.  Among those encountered are reduced or absent saliva, infections, progressive scarring, as well as difficulties wearing dental prosthetics.  Together with the emotional and physical scars, these are continuous reminders of their illness.  It hurts their ability to live full and happy lives.

What is Going to be the Biggest Problem?

The biggest complaint reported to me is the persistent lack of saliva.  Radiation does a good job killing cancer tissue, but our saliva glands are extremely sensitive to it.  The salivary gland locations make it difficult to avoid them in treatment.  There are techniques to reduce exposure, however, few finish treatment without some damage.

Why is that so important? Our bodies have evolved so our mouth is a moist environment.  The entire oral cavity is a delicately balanced system that relies on staying hydrated to function properly.  If you change one part of that, the balance shifts and problems arise.

Without enough saliva, survivors lose the ability lubricate their mouth.  This causes difficulty controlling  acids, impairs speech, makes it hard to eat food, creates problems wearing dentures, and fight infections.  Just one of these issues is enough to cause disruption in a sufferer’s daily life.  Imagine not being able to talk to family or coworkers comfortably, to eat lunch, or wear your denture due to pain.  This is a reality for hundreds of thousands of survivors every day.

What Else Changes?

The tissues and teeth also change after radiation.  Teeth show changes that make them more prone to chipping.  Muscles show scarring that requires physical therapy.  Plus, survivors see a reduction in blood supply to bone making it difficult to heal.

While the brittleness of the teeth and muscle scarring can be managed to some extent, poor blood supply to the bone is beyond people’s ability to control.  Very often, prior to beginning treatment, patients undergo the removal of some or all of their teeth.  This becomes a significant problem for surgeons and patients after radiation if work is needed.  If a survivor’s natural tooth becomes unfixable, the only option is to remove it, and many who have lost their teeth want to use dental implants to resolve this.

Both tooth removal and placement of implants are surgeries.  Both are invasive and traumatic.  A good blood supply is needed to heal.  In areas of radiation, every patient is susceptible to developing osteoradionecrosis or ORN.  This is when the surgery site does not heal due to the lack of a sufficient blood supply.  The result can require removal of large amounts of bone to halt the process and reach areas with better blood flow.  Unfortunately, this isn’t always possible and disfiguring surgeries can result.

Nobody Should Go It Alone.

Being the survivor of head and neck cancer requires a lifetime of care and support.  All health care providers should inform them of what to be aware of before, during, and after treatment.  The first line of defense is knowledge.  Knowing what the long-term effects of treatment are is critical for these patients so they can better manage themselves.  Until treatments other than radiation are developed, survivors will continue to experience these issues. Everyone involved in the care process (patients, physicians, dentists, and dental hygienists) should work closely together for the best result.

  • Deborah Anderson

    How about radiation affecting your thinking, like forgetting etc

    December 2, 2021 22:12
  • Michelle

    I’am a 2 time cancer survivor , once head& neck, once kidney.. All of my side effects came late, about 2 years after treatment stopped.Chronic Fatigue is here to stay! Dry mouth is here to stay! Loosing hair here to stay, weight gain due to my thyroid being taken by the radiation , here to stay! I’am very blessed to still be able to eat& blessed to be alive!! I take one day at a time…everyday is a precious gift , I pushed through whatever pain I have that day..

    December 3, 2021 00:12
  • A Fortyeight Year Survivor

    Good to see this issue being talked about but this only addresses the tip of the iceberg especially for those treated with the earliest radiation protocols (1960-1990)
    In my experience and that of many of my peers many other late effects dont start to be an issue until 30 plus years after treatment
    I would agree It would be a huge plus if my ten consultants now required for my care could work together

    December 3, 2021 19:12
  • Marshall

    I am 11 years out. My teeth are now in full revolt and the dental issues keep coming.

    The other amazing thing is how few doctors understand or can help with a feeding tube. I’ve had my permanent feeding tube four years now and their is little to NO support in the field for that. We’re it not for social media groups for tube feeding, I’d be much worse off.

    December 4, 2021 06:12
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