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Radiation and Oral Surgery Torrance, CA

Radiation and Oral Surgery

Radiation to the head and neck is a common form of adjuvant therapy for treatment of cancer. There are about 30,000 cases of H&N cancer yearly. Radiation has a greater ability to destroy neoplastic cells while sparing normal cells. It also interferes with reproduction and cell maintenance of normal tissues including hematopoietic cells/epithelial cells/endothelial cells.

Radiation will impart effects on the oral mucosa, which can be divided into initial and long term. Initial effects are within the first 2 weeks and include: erythema to severe mucositis, pain and dysphagia leading to inadequate nutritional intake and loss of sense of taste. Long-term effects include: less keratinized epithelium, delayed healing, decreased tissue vascularity, and mucosal ulcerations.

Effects are also seen on salivary glands. The destruction is secondary to effects on the vasculature, with insult resulting in atrophy, fibrosis and degeneration. Manifestations of salivary gland injury include xerostomia: loss of protective enzymes to fight bacteria and increase in caries incidence. Treatment of xerostomia includes: hydration, saliva substitutes (glycerin), sugar-free gum and parasympathomimetic agents including Pilocarpine HCL.

Radiation effects on bone are due to the detrimental effects on the vasculature. Bone becomes virtually non-vital and is essentially incapable of self-repair. Sharp areas on alveolus ridge will not smooth themselves.

As the general dentist you want to evaluate the patient prior to radiotherapy and address the dental concern. Teeth with periodontal disease will worsen post radiation and they should be extracted. Patients with a good history of oral hygiene will maintain that in the future and we should retain as many of their teeth as possible. If patients have neglected their oral health for years, they will continue to do so. Immediacy of radiotherapy– at times emergent radiation is needed and cannot wait for extraction, in these situations the dentist and the patient need to work closely with each other to maintain the patient’s oral health as optimally as possible

In preparation for radiotherapy, we need to education the patient by reviewing oral hygiene measures, prophylaxis with topical fluoride, smoothen sharp cusps and fabricate custom fluoride trays.

If prior to radiation it is best to perform atraumatic exodontia, obtain primary soft tissue closure, smoothen all sharp bony areas and prophylactic antibiotics should be used. After the extraction, the patient should wait 14 days to begin radiation to allow for epithelialization to occur. If a patient has impacted 3rd molars they should be extracted if partially erupted and left alone if fully bony.

Caries in patients after radiotherapy should be immediately addressed. It is best to restore with amalgam or composite and not crowns, as it is difficult to detect recurrent caries.

An extraction after radiotherapy is up for questioning. Some practitioners feel it is best to do a RCT, coronoectomy and leave the tooth in place, while others will have the patient undergo hyperbaric O2 therapy. With hyperbaric O2 therapy, it is believed to increase local tissue oxygenation and vascular ingrowth. 20 dives prior and 10 dives immediately after the extraction is required. Studies have shown this will decrease osteoradionecrosis from 30% to 5.4%. It is always best to consult with the radiation oncologist.

It always best to have an oral and maxillofacial surgeon to care for these patients as they may need extensive follow up and care with wound management. Let Dr. Benjamin Yagoubian care for your patient with advances medical conditions.

Posted on behalf of Torrance Oral Surgery Center

23451 Madison St #120
Torrance, CA 90505

Phone: (310) 373-0667

Email:

Monday 8AM - 5PM
Tuesday 8AM - 5PM
Wednesday 8AM - 5PM
Thursday 8AM - 5PM
Friday 8AM - 5PM

Address:

23451 Madison St #120
Torrance, CA 90505

Phone:

(310) 373-0667

Office Hours:

Monday 8AM - 5PM
Tuesday 8AM - 5PM
Wednesday 8AM - 5PM
Thursday 8AM - 5PM
Friday 8AM - 5PM

Torrance Oral Surgery Center

Our Client Reviews

5.0/ 5.0

Based on 34 reviews

Paul M.

A positive experience from start to end. I got a sense that this was going to go well and it did. Two extractions, two implants, bone graft and removal of four part bridge. Leaving part of the bridge on one tooth. If there were 10stars they would be for Torrance oral surgery group and Dr. Alicia Wolf / Blanco Demtal Group for recommending Ben.

Mindy W.

This is a very welcoming center. Everyone seemed very competent and helpful. I had an oral biopsy today. No waiting. The staff were ready for me and all was in place. Dr. Yagoubian was warm , cheerful and I felt in extremely capable hands. I am so grateful I was referred to him. Sincerely, Mindy W.

Jessica Z.

The staff here are super friendly and always show genuine concern. I got my wisdom teeth pulled about a year ago and Dr. Yagoubian and his staff made me feel less anxious about the procedure. When I was done, they were thorough with their instructions on how to take care of myself while my wounds healed. They even gave me an ice pack to wrap around my head for the swelling (super useful). Dr. Yagoubian even called to check in on me after the surgery. So when I needed more extractions done this year for orthodontic treatment, I made an appointment here and once again I was well taken care of. Every single person in this office was friendly. During the procedure, they made me feel less anxious even though I was super shaky about getting local anesthesia. They gave me detailed instructions on how to care for my wounds, always gave me an opportunity to ask questions. And once again, Dr. Yagoubian called after the procedure to make sure I was doing well. Now, anytime someone mentions they need their wisdom teeth removed, I tell them Dr. Yagoubian is the man!!

D. W.

What a nice and knowledgeable Doctor! Dr. Ben took the time to answer all our questions about the removal of all four wisdom teeth. He explained in detailed what was going to happen and the reason why he does the procedure. It’s obvious that he loves what he does. His staff is very welcoming and friendly. The nice lady in charge of the billing explained very clearly everything. Dr. Ben even called us the evening after the surgery to check if everything was ok. We highly recommend Dr. Yagoubian!

Chahab S.

Dr Yagoubian is an excellent oral surgeon, supported by a very professional staff. They made the experience as stress-free as possible. Highly recommended.

Dr.Lou T.

Very professional and always available. My patients have always had good experiences with the office.

JOHNNY P.

Dr. Benjamin is awesome I highly recommend him to everyone he is highly efficient and fast he knows how to comply with patient needs and overall is an amazing guy ! Check him out he is awesome!!!

Raj G.

Dr. Yagoubian is excellent. I was in state for business when my wisdom tooth broke. I was lucky enough to find Dr. Yagoubian's office. Everyone there was professional and courteous. The procedure went smoothly. Dr. Y is highly skilled, meticulous, and a very personable health care provider (a rarity in the field, in my opinion). If you need an oral surgeon, I highly recommend him.