Table 2.
Assessment and treatment of oral foci within or outside the radiation field
| Assessed tooth problems | Treatment if cumulative dose > 40 Gya | Treatment if cumulative dose < 40 Gy or outside the radiation portala |
|---|---|---|
| Caries profunda | Tooth extraction | Restoration, if necessary combined with endodontic treatment, or tooth extraction |
| Periapical pathosis (on radiographs) without symptoms and/or additional problems | In teeth without root canal filling: endodontic treatment and/or apexification In teeth with root canal filling: endodontic re-treatment, apexification, or tooth extraction (needed in case of pre-radiotherapy time limitations) |
In teeth without root canal filling: endodontic treatment In teeth with root canal filling: endodontic re-treatment, apexification, or tooth extraction Treatment can be postponed until after radiotherapy |
| Extensive periapical pathosis (on radiographs) combined with periodontal disease, in afunctional teeth or with symptoms | Tooth extraction | In teeth without root canal filling: endodontic treatment combined with initial periodontal treatment In teeth with root canal filling: endodontic re-treatment, apexification, or tooth extraction depending on the prognosis |
| Avital pulp with symptoms without periapical radiolucency on radiographs | Endodontic treatment or tooth extraction (which might be necessary in case of pre-radiotherapy time limitations) | Endodontic treatment or tooth extraction depending on the prognosis |
| Avital pulp without symptoms and without periapical radiolucency on radiographs | Endodontic treatment or tooth extraction (needed in case of pre-radiotherapy time limitations) | Endodontic treatment (which can be postponed until after radiotherapy) |
| Periodontal disease with: Pockets 4–5 mm Pockets ≥ 6 mm Gingival recessions ≥ 6 mm |
Initial periodontal therapy Tooth extraction Tooth extraction |
Initial periodontal therapy Initial periodontal therapy Only recession requires no treatment |
| Impacted teeth or roots fully covered by bone without radiographic abnormalities | No treatment If problems are expected in the future: tooth extraction |
No treatment |
| Impacted teeth or roots not fully covered by bone or with radiographic abnormalities (e.g., cysts, apical radiolucency) | Tooth extraction | No treatment or, in case of symptoms, surgical removal Roots with periapical radiolucency might be worth preserving by endodontic treatment and restoration (which can be postponed until after radiotherapy) |
| Cysts | Surgical removal | Surgical removal |
| Internal or external root resorption | Tooth extraction | Endodontic treatment or tooth extraction depending on the prognosis |
aIf an irradiated patient needed treatment, radiation fields were always verified with the department of Radiation Oncology, and depending on the dose in the specific region where treatment was needed, antibiotic prophylaxis was given to the patient