[Prevention of caries and osteonecrosis through daily local fluoridation in radiotherapy patients]

The healthy dentition of 432 patients treated by radiotherapy for ENT and salivary gland lesions was preserved and subjected to a programme of strict hygiene and daily local fluoride application using a gel containing 1% of sodium fluoride. Effectiveness in terms of the prevention of caries was satisfactory. Caries developed in only 7% of the patients. None of the patients in whom there was a clear indication and who followed treatment carefully to an extent greater than 70% suffered decay. Thorough initial assessment, and very careful selection of cases should make it possible in the future to avoid the majority of sources of failure observed. The prevalence of osteo-necrosis secondary to dental preservation was 1.2%, identical to the prevalence of trophic complications seen in patients who underwent total extraction before radiotherapy. The technique of fluoride application is simple, with no risk of toxicity, but must be continued indefinitely. Preservation of the dentition must be undertaken only with the close cooperation of the responsible medical and odontological teams, the latter being responsible for the initial assessment, care and surveillance. Preservation of a healthy dentition together with the possibility of early fitting of a prosthesis if necessary contribute to the rapid functional rehabilitation of patients irradiated for malignant disease in the ENT area.