# Dental assessment before head and neck radiotherapy and osteoradionecrosis prevention

Source: https://onco.cc/protocols/head-and-neck-radiotherapy-dental-assessment-osteoradionecrosis/  
OnCo record `head-and-neck-radiotherapy-dental-assessment-osteoradionecrosis` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Radiotherapy to the mouth and jaw lowers the jawbone's ability to heal for the rest of your life, so a dentist should check your teeth before treatment starts and take out any that are unlikely to last, giving the gums time to heal. Afterwards, careful dental care for life and telling your dentist about the radiotherapy before any extraction help prevent bone damage called osteoradionecrosis.

## Summary

The current guideline is ISOO-MASCC-ASCO 2024 (Peterson et al.), which could be read only as an abstract: it rated the prevention best practices and surgical management as evidence-based with strong evidence, relied on informal consensus elsewhere, made no recommendation on leukocyte- and platelet-rich fibrin or photobiomodulation for prevention, and judged hyperbaric oxygen for prevention or management largely unjustified. NCI PDQ (2024) sets out the pre-treatment dental work for high-dose head and neck radiotherapy: decide which teeth need extracting (advanced caries near the pulp, moderate or severe periodontal disease, periapical lesions symptomatic within 90 days, traumatising appliances), evaluate as early as possible so extraction sites can heal, maintain hygiene, prescribe jaw exercises against trismus and monitor for osteoradionecrosis. MASCC/ISOO 2020 gives expert opinion that dental evaluation and treatment before cancer therapy are desirable. On timing, a 2026 meta-analysis of eight retrospective cohorts found no overall link between the extraction-to-radiotherapy interval and osteoradionecrosis but higher risk in Western populations starting within 7 or 14 days; a 2022 meta-analysis in IMRT found extraction before radiotherapy has not been proven to reduce osteoradionecrosis compared with after, to be weighed against delay. For established osteoradionecrosis NICE NG36 says consider surgery to remove necrotic bone with soft tissue cover, and hyperbaric oxygen or medical management only within a trial.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: dental check before radiotherapy; pre-radiotherapy dental assessment; osteoradionecrosis prevention; ORN of the jaw; jaw bone damage after radiotherapy; tooth extraction before radiotherapy; dental extraction and radiotherapy

## Connected records

- protocols: [Immobilisation mask for head and neck and brain radiotherapy, including mask anxiety](https://onco.cc/protocols/head-and-neck-radiotherapy-immobilisation-mask/), [Mouth care and oral mucositis prevention during head and neck radiotherapy](https://onco.cc/protocols/head-and-neck-radiotherapy-oral-mucositis/), [Oral care and oral mucositis prevention during cancer treatment](https://onco.cc/protocols/oral-mucositis-prevention-and-oral-care/)
- cancers: [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [Oral cavity cancer (mouth and tongue)](https://onco.cc/cancers/oral-cavity-cancer/), [Oropharyngeal cancer (tonsil and base of tongue)](https://onco.cc/cancers/oropharyngeal-cancer/)
- technologies: [Dry mouth, teeth and taste after head and neck radiotherapy](https://onco.cc/technologies/dry-mouth-teeth-after-head-neck-radiotherapy/), [Hyperbaric oxygen for late radiation injury](https://onco.cc/technologies/hyperbaric-oxygen-radiation-injury/)
- ideas: [Settling the minimum gap between dental extraction and the start of head and neck radiotherapy](https://onco.cc/ideas/idea-pu-dental-extraction-healing-interval/)

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