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Pathology · patient case question

Which is the most important dental measure BEFORE oncological treatment begins?

Patient case: Patient scheduled for head and neck chemotherapy

Patient: Adult with a head and neck malignancy

Chief complaint: Referred for dental assessment before oncological treatment.

Background: Due to commence chemotherapy for a head and neck tumour.

Current findings: Baseline pulp testing performed as part of the pre-treatment assessment.

  1. Fabricate new complete dentures
  2. Defer all dental treatment until oncological therapy is finished
  3. Complete all planned aesthetic treatment
  4. Eliminate all active infection and extract non-restorable teeth, allowing time for healing
Show answer and explanation

Correct answer: D. Eliminate all active infection and extract non-restorable teeth, allowing time for healing

  • A. New dentures fitted before mucositis develops will not fit the altered tissues afterwards.
  • B. Deferring is precisely wrong — the pre-treatment window is the safest time to intervene.
  • C. Elective aesthetic work is not a priority and consumes the limited pre-treatment window.
  • D. CORRECT. The pre-treatment window is used to remove sources of infection. Extractions should ideally precede radiotherapy by at least two to three weeks to allow mucosal healing, because afterwards the risk of OSTEORADIONECROSIS makes extraction in irradiated bone hazardous. Fluoride trays, hygiene instruction and prosthesis assessment also belong to this phase.

Note: Carry the numbers: extractions at least 2–3 weeks before radiotherapy. Afterwards, extraction in irradiated bone risks osteoradionecrosis, and the risk is lifelong.

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