Prevention of ORN is an extremely important part of the comprehensive
management of patients who undergo external beam
radiation therapy to the head and neck. All patients should undergo
prophylactic oral care prior to, during, and after the completion
of radiation therapy. All diseased teeth should be extracted. The
optimal time for extraction of teeth is 21 days prior to initiating
radiation therapy (no less than two weeks before starting therapy).
15 Less optimally, extractions can be performed within four
months of completion of therapy. All patients should be instructed
on meticulous oral hygiene and fluoride should be applied to the
dentition daily via custom molded trays. Patients should undergo
weekly checkups during radiation therapy and monthly thereafter
for the first six months. Following this early post-treatment period,
the patients should see their dentist every four months. The reason
behind this ‘‘close follow-up” schedule is to monitor the patient’s
compliance with meticulous oral hygiene and the daily application
of topical fluoride. Cervical root caries, common in xerostomic patients,
must be treated promptly in order to avoid involvement of
the pulp chamber or undermining the structure of the clinical
crown. Those who require dental extractions more than four
months after radiation therapy should be treated with HBO. The
Marx protocol of 20 dives at 2.4 atmospheres for 90 min per dive
before extraction and 10 dives after extraction has become the
de facto standard