Current Evidence on Best Practice Dental Survivorship Care for People With Head and Neck Cancer: An Overview of...

Head and neck cancer (HNC) survival is improving, increasing the need to address long-term survivorship issues. Dental survivorship-care before, during, and after treatment-remains inconsistent across services. We conducted a review of systematic reviews and emerging evidence to inform contemporary dental survivorship care for HNC patients.

This review followed PRISMA guidelines. Eligible studies included adults with HNC receiving oral and dental interventions before, during, or after treatment. Medline and CINAHL were searched in September 2025, with two reviewers screening and extracting data. Risk of bias was assessed with study-specific tools. Due to heterogeneity, findings were synthesized narratively and grouped thematically.

Our search identified 2985 studies, of which 41 met inclusion criteria. For prevention of dental caries, fluoride was consistently effective, while evidence for casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and intra-oral devices was mixed. Dental optimization before radiotherapy, including extraction of teeth with poor prognosis where indicated, is widely recommended; however, the effect of extraction timing on ORN risk remains uncertain. Hyperbaric oxygen and the PENTO protocol (pentoxifylline with tocopherol) showed limited or conflicting benefit in reducing ORN risk when used as an adjunct to tooth extractions. For dental implants, immediate placement at the time of surgery (and, therefore, prior to radiotherapy) may improve prosthetic rehabilitation. Where reconstruction was required after oncologic surgery, fibula free flap reconstructions yielded favorable outcomes for dental implant survival. Inclusion of dental professionals in the HNC multidisciplinary team improved oral outcomes, quality of life, and adherence to preventive protocols. Referral proformas and community dentist involvement in survivorship care increased compliance and access.

Overall, evidence supports preventive dental interventions and early integration of dental professionals in HNC care. Findings from this review will guide planned consensus practice guidelines to reduce variations in HNC dental survivorship care across services.