Targeted Oral Health Management in Patients Undergoing Radiotherapy

PURPOSE: Radiotherapy for head and neck carcinoma induces a rapid, aggressive degradation of the oral environment, characterised by a 50% reduction in salivary flow and a plummeting of oral pH from 7.0 to 5.0. These physiological changes, combined with direct dose-dependent damage to dental hard tissues, lead to “radiation caries” and atypical decay. This narrative review highlights the clinical considerations and management strategies required for patients undergoing radio-therapy who require endodontic treatment. SEARCH METHODS: A search of the Pub-Med/Medline, Google Scholar and Cochrane Library databases from 1939 until 2025 using the keywords “endodontics radiotherapy”. After screening for English language, availability of full text, and excluding paediatric studies, an extensive review was performed. SEARCH RESULTS: A total of 121 studies and 5 books were captured. 30 articles were excluded, and finally, 91 studies were reviewed. DISCUSSION AND CONCLUSION: Endodontic therapy is often the preferred choice over extraction to minimise trauma to irradiated bone and avoid the development of oste-oradionecrosis. Success rates for root canal treatment in these patients are comparable to non-irradiated populations, even at mean doses of 66.25 Gy. Technical adaptations for endodontic success include using systemic antibiotics, maintaining strict asepsis under a rubber dam, and es-tablishing a safe working length to prevent periapical trauma. Challenges such as trismus and oral mucositis can be managed through muscle massage and probiotics, apart from the conventional approach. A phased management strategy—stabilising the dentition three weeks before radio-therapy, monitoring during therapy, and applying specialised technical adaptations post-radiation—effectively preserves oral health. By adhering to precise protocols, endodontic treatment serves as a vital safeguard against the evitable loss of dental function and morbidity.