A patient reports a history of radiation therapy to the head and neck and now requires an extraction of a hopeless molar. What is the BEST next step before proceeding?

Correct answer: D. Contact the radiation oncologist to obtain the total radiation dose and the treatment fields

• A. ❌ Atraumatic technique matters, but it is not the FIRST step — you cannot judge whether surgery is appropriate at all until you know the dose and field.
• B. ❌ Prosthetic planning is a later conversation. It does not address the immediate surgical risk.
• C. ❌ Antibiotics do not prevent osteoradionecrosis. Prophylactic antibiotics without knowing the radiation dose and field is treating blind.
• D. ✅ CORRECT — Before any surgery in an irradiated patient you must know the CUMULATIVE DOSE and the exact FIELDS. Osteoradionecrosis risk rises sharply above roughly 60 Gy, and the risk applies only to bone that was actually inside the radiation field. Dose and field determine whether extraction is safe, whether hyperbaric oxygen is considered, and whether the case should be referred.

Note: Key numbers: ORN risk climbs above ~60 Gy. Mandible >> maxilla (poorer collateral blood supply). Ideally extractions are completed 2–3 weeks BEFORE radiation begins.