Prevention of caries and of osteoradionecrosis in patients irradiated in oncology

: Dental lesions following radiation therapy of the head and neck cancers are known for a long time, and the role of a decreased salivary function in the induction of radiation caries has been recognized by Del Regato in 1939. The salivary glands are most frequently included in the radiation fields for the treatment of lesions of the upper aero-digestive tract; they are also irradiated, in variable proportion, in other conditions such as Hodgkin's disease. From a clinical point of view, the dental caries observed after radiation therapy are diffuse and rapidly evolutive. However, from a histological point of view, they are similar to the current type of dental caries. Daily application of fluoride has been shown to prevent the appearance of the caries and of the related osteo-radionecrosis. The experience of the Cancer Centre Georges-Francois Leclerc of Dijon is reported and especially the results of randomized prospective studies concerning the efficiency of the fluoride prevention. Taking into account the available clinical experience, it seems reasonable, at present, to state that preservation of teeth, in irradiated patients should be the rule and not the exception, given good dental conditions prior to the treatment and patient collaboration. The 5 minutes daily application of fluoride gel is the most reliable method for prevention of post-irradiation dental caries. The twice daily use of high-content fluoride tooth-paste is a good alternative, provided its limitations are well understood by the clinician and the patient. The systematic use of high-content fluoride tooth-paste for the prevention of caries in the general public is discussed.