Stomatological management of head and neck cancer patients treated with chemotherapy and radiotherapy

Table 1 Common complications of the head and neck region following radiotherapy

Complication	Characteristics	Time of appearance	Prognosis
Erythema/ radiodermatitis	Redness/decreased skin thickness; skin dryness due to epidermal basal cell damage	Immediate	Reversible
Mucositis	Generalized inflammation of the oral mucosa due to basal cell damage; scaling, mucosal ulcerations	Immediate	Reversible
Dysgeusia	Altered taste (especially to sour and acid tastes) due to taste bud damage	Immediate	Reversible
Glossodynia	Pain and burning sensation in the tongue due to taste bud damage and inflammation	Immediate	Reversible
Candidiasis and Herpes simplex	Secondary infections resulting from loss of mucosal protection caused by mucositis and xerostomia	Immediate	Reversible
Xerostomia	Decrease in salivary flow and dryness of the mouth caused by alterations in salivary glands	Immediate	Irreversible at high radiation doses (more than 60 Gy)
Periodontal disease	Inflammation of the periodontium due to augmented plaque from decreased salivary flow	Immediate	Reversible
Alopecia	Hair loss from hair follicle atrophy	Immediate	Reversible
Severe necrosis	Loss of tissue, scurvy and malodorous ulcerations	Immediate	Irreversible
Trismus	Reduced mouth opening caused by fibrosis of the muscles of mastication or of the temporomandibular joint	Medium-term	Reversible/irreversible
Caries	Damage to the cement-enamel junction, incisal edges and cusps caused by decreased salivation	Medium-term	Irreversible
Dysphagia	Difficulty swallowing food caused by oropharyngeal alterations; may be evidenced by malnutrition	Medium-term	Reversible
Dental hypersensitivity	Dental sensitivity caused by radiation	Medium-term	Reversible
Osteoradionecrosis	Aseptic necrosis of the irradiated bone	Late	Irreversible
Tooth germ alterations	Alteration in odontogenesis in pediatric patients	Late	Irreversible
Pulp necrosis and pain	Pulp necrosis and pain	Late	Irreversible