prophylactic tx of radiation pts.

[rambo2006]

Hello every1,

I was referred a pt to have a dental clearance before having radiation to the area of the brain just above the cribiform plate. I understand that any teeth that have a questionable px or advanced perio should be prophylacticly ext'ed. That said, is there any literature/publications, or existing protocol on what teeth to ext that appear within normal limits before radiation, that take in consideration the dosage and directions of the beams/fields of radiation?

thanks,

Rambo

 

[ObviousGuy]

We get referrals for these at least two times a week . Usually the patient has no idea why they are there. We explain the risks of ORN, etc. and then request a dose and field from rad onc.

As an example we may get a form from the radiation guys that says this:

Post mand 7000
Post Max 7000
Ant max 4500
Ant mand 4500

Etc.

Marx's book has a great few pages of osteoradionecrosis that I would read. Depending on your patient population and the condition of their teeth, sometimes it is prudent to slick them all.

Usually anything in the way of 6000+ gets slicked at our place. If the dose is 4500 and the teeth are in bad shape = slicked.

I always tell the patient they can still develop ORN even though the teeth are gone so they have no suprises when we have to go back in later for debridement and/or resection.