Treatment usually requires surgical procedures to remove the dead tissue and reconstruct it. To prevent osteoradionecrosis from occurring in the first place, various measures are taken before, during and after radiotherapy to prevent bone death.
Osteoradionecrosis of the upper and lower jaw is a rare side effect of radiotherapy in the head and neck area. It leads to the death of bone tissue. As a result, various symptoms can occur - ranging from pain or swelling in the jaw area to fractures in the jawbone.
Treatment usually requires surgical procedures to remove the dead tissue and reconstruct it. To prevent osteoradionecrosis from occurring in the first place, various measures are taken before, during and after radiotherapy to prevent bone death.
Osteoradionecrosis of the upper and lower jaw is characterized by the death of bone tissue in the jaw due to radiation. The bone suffers long-term damage because the radiation damages the blood vessels in the jawbone and the bone tissue is no longer adequately supplied with nutrients and oxygen. As a result, the bone tissue can no longer adequately defend itself against pathogens, making infections in the jaw area more likely.
Such osteoradionecrosis can occur if radiotherapy has been used to treat cancer in the head and neck area (so-called head and neck cancer). This group of cancers includes, for example:
Osteoradionecrosis is ultimately a side effect of radiotherapy, but fortunately only develops in rare cases. The death of the bone tissue does not occur immediately, but only several months to years after the end of radiotherapy.
Osteoradionecrosis occurs mainly in the lower jaw. The risk of radiation-induced bone death is higher here because the blood flow in the lower jaw is comparatively low anyway. In the upper jaw, however, osteoradionecrosis develops only very rarely.
The cause of osteoradionecrosis in the upper and lower jaw is radiation therapy (radiotherapy), which is used to treat cancer in the head and neck area (so-called head and neck cancer). In rare cases, osteoradionecrosis may develop some time later.
Certain factors can increase the risk of osteoradionecrosis in the upper and lower jaw. The most important risk factor is the radiation dose chosen for the treatment. The risk increases from a dose of more than 50 gray. The risk also increases if the bone is exposed during irradiation.
There is also a higher risk of osteoradionecrosis if the condition of the teeth was not checked before radiotherapy and any necessary dental repairs could not be completed before radiotherapy. If good oral hygiene is not maintained before and after radiotherapy, the risk can also increase. Another risk factor is dry mouth. This can develop as a result of radiotherapy.
Jaw injuries are also considered a risk factor, especially if they occur within the first twelve months after radiotherapy. Such injuries can occur, for example, when a tooth is extracted or a dental implant is placed, during surgery or when a tissue sample (biopsy) is taken from the jaw, if the jaw is irritated by a prosthesis or as a result of an accident.
Certain pre-existing conditions such as diabetes mellitus (diabetes), which are often associated with wound healing disorders, as well as lifestyle habits that have an unfavorable effect on wound healing processes (such as smoking or heavy alcohol consumption), can also increase the risk of osteoradionecrosis.
The symptoms of osteoradionecrosis of the upper and lower jaw depend on the severity and extent of the bone death. When bone tissue in the jaw deteriorates, it is damaged and weakened. This can lead to pain and other symptoms.
In order to diagnose osteoradionecrosis of the upper and lower jaw, we first carry out a thorough physical examination, taking a closer look at the head and neck area in particular.
The medical records for radiotherapy are also of interest. This is because it records exactly which area of the head was irradiated and how high the total radiation dose was.
Various imaging examinations can also be helpful for the diagnosis, as they provide a better insight into the jaw tissue itself. Examples of this are
A tissue sample (biopsy) can show whether the cancer has possibly returned or whether metastases of the cancer cells have developed.
In order to reduce the risk of osteoradionecrosis of the upper and lower jaw, various preventive measures can be taken before, during and after radiotherapy of the head and neck area.
Before starting radiotherapy in the head and neck area, patients should schedule an examination by a dentist. This makes it possible to recognize the condition of the teeth in good time and whether there is a need for action in certain areas. Carious areas, for example, should be filled with fillings, leaking fillings replaced and, if necessary, decayed teeth extracted before radiotherapy. Necessary dental treatment should be completed at least ten to fourteen days before the start of radiotherapy.
Before, during and after radiotherapy, you should pay particular attention to thorough oral and dental hygiene. This is because healthy teeth and gums are important for good healing after radiotherapy. Professional teeth cleaning (PZR) is therefore also advisable before radiotherapy. On the one hand, to remove plaque and tartar, which can be the cause of gum inflammation, and on the other, to get tips on optimal oral and dental care.
It is also important to fluoridate your teeth before, during and after radiotherapy. For this purpose, special fluoridation splints are made for the upper and lower jaw, which are worn at night – similar to a grinding splint. This allows the fluoride preparation to act for a sufficiently long time.
During radiotherapy, so-called radiation protection splints are often used, which are also individually made and worn on the upper and lower row of teeth.
During and after radiotherapy, it is important to have regular dental check-ups and to have dental conditions (such as tooth decay) or gum conditions (such as gingivitis or infections) treated promptly. You should wait until radiotherapy is complete before carrying out any procedures that could damage the jawbone (such as extracting teeth or placing dental implants).
If severe dry mouth (xerostomia) occurs as a result of radiation treatment, measures such as saliva substitutes (for example in the form of mouth rinses, mouth gels or mouth sprays) or certain medications that stimulate the flow of saliva can help.