Dental rehabilitation of the patient with severe caries after radiation therapy.

Dental management of the patient with severe caries after radiation therapy can be accomplished by the general practitioner in an office setting. Because of the decrease in vascularity that results from radiotherapy, the general practitioner must keep the following points in mind when treating these patients: Extraction of teeth that were in the field of radiotherapy is contraindicated. If there is a question about a possible extraction, consultation should be made with the patient's radiotherapist and a hospital-trained dentist (preferably, an oral surgeon). Endodontic treatment is the only treatment indicated for pulpally damaged teeth in the field of radiotherapy. When endodontic treatment is done, the following precautions are necessary: all teeth that are an immediate source of infection must be treated first; prophylactic antibiotics should be administered for the duration of treatment'; all endodontic procedures must be administered in an aseptic field of treatment--if a tooth is badly deteriorated as a result of severe caries, a copper band should be used with a rubber dam and no tooth should ever be left "open for drainage" in these patients; temporary fillings should be of sufficient strength to prevent contamination between appointments; tooth-length determination should be done with precision--instrumentation beyond the apex should be avoided; caustic irrigating solutions such as sodium hypochlorite should be avoided--sterile water or sterile saline solution is preferable. For fabrication of prostheses, the general practitioner should be aware that: metallic-oxide impression materials such as zinc-oxide and eugenol should be avoided because of their irritating properties; trismus is common when the masticatory muscles are bilaterally in the field of radiotherapy-therefore, to prevent encroachment on the freeway space for these patients, the vertical dimension of occlusion should be decreased accordingly; monoplane teeth are preferable to cusped teeth for patients with trismus because their border movements are often irregular-monoplane teeth cause less interferences and are easier for the patient to manage; a remount of the overdentures to check the occlusion as well as a careful examination of flange extensions are necessary to prevent tissue ulcerations that could lead to tissue and bony necroses. Cast restorations should be avoided for patients with severe caries after radiation therapy (for example, a cast core and dowel). Prevention of postradiotherapy treatment complications is the primary goal in the management of the patient who has had head and neck cancer. If, however, the patient who has received radiation therapy and as a result has severe caries does come to the general practitioner, a logical and organized treatment plan can be followed that will result in control of the carious disease process and the functional rehabilitation of the patient.