Before radiotherapy begins for head and neck cancer, there’s often a critical decision to make:

should certain teeth be removed to reduce the risk of complications like osteoradionecrosis (ORN)?

It’s not a decision anyone takes lightly. Pre-radiotherapy dental extractions can help prevent ORN, a serious and sometimes debilitating condition affecting the jawbone. However, extractions can negatively impact function, appearance, and quality of life, so minimizing unnecessary removal is essential.

Striking the right balance is critical. Minimising unnecessary dental extractions while safeguarding against ORN remains a challenge. Until now, the decision has often relied on broad estimates of radiation dose and a cautious “just in case” approach.

To address this, the team at the South West Wales Cancer Centre conducted a retrospective study aimed at improving decision-making. Our study analysed over 100 radiotherapy plans, mapping the average dose received by individual teeth according to tumour site and T-stage. The aim was to identify patterns that could guide dental decisions before treatment begins.

The results showed:

• Oral cavity tumours, particularly at stage T2 and above, consistently delivered high doses to lower molars on the tumour side. These doses often exceeded 50Gy, which is commonly associated with increased ORN risk.
• In contrast, patients with laryngeal tumours gave very low dental doses, suggesting that extractions in these cases may be unnecessary.
• Across nearly all tumour sites, lower teeth received significantly higher radiation doses than upper teeth, a key consideration when weighing up extraction risks.  

This detailed dose mapping hasn’t previously been available to dental and oncology teams at the pre-treatment stage. With improved understanding of which teeth fall into high-dose regions, the study supports a shift from reliance on educated guesswork to evidence-informed decisions.

Avoiding unnecessary tooth extractions can lead to:

• Less disruption to how a patient eats, speaks, and smiles.
• Fewer treatment delays while healing occurs.
• Improved quality of life during and after cancer treatment.

Equally, identifying high-risk teeth enables timely, preventive extractions without delaying radiotherapy.

The authors hope this work contributes to more personalised, data-driven decision-making for people undergoing radiotherapy for head and neck cancer. Although future research is needed to directly link these tooth doses to long-term ORN outcomes, the current findings already offer valuable clinical guidance. Cancer treatment is complex, but decisions like whether a tooth should stay or go shouldn’t rely on guesswork. This study represents a step forward towards safer, more patient-centred dental decision-making for radiotherapy patients.