The dental problems of patients with head and neck cancer treated with CHART

Between 1985 and 1990, 99 head and neck cancer patients were treated at Mount Vernon Centre for Cancer Treatment in a CHART pilot study. The aims of this retrospective review were to obtain baseline data for this population on their pretreatment dental status and to determine the extent to which our conservative policy of teeth preservation is being realised. This is of particular interest because of the believed sparing of late normal tissue effects by CHART compared with conventional fractionation. Prior to treatment, 40% of patients were edentulous, and prophylactic dental clearance was avoided in 59% of the remaining (dentate) patients. Following radiotherapy, only 21% of dentate patients subsequently lost all their remaining teeth. The proportion of patients with full or partial upper dentures increased from 61% pretreatment to 76% post-treatment; the corresponding increase in lower dentures was 46% to 66%. However, actual usage of dentures decreased somewhat. There was only one documented case of (minor) osteo-radionecrosis of the mandible which resolved with conservative care. The greater use in our patients of prophylactic measures, in particular, chlorhexidine and fluoride mouthwashes seemed indicated.