CJ Henley, DMD, PA / San Marco, Jacksonville, Florida
Dental exam before head and neck radiation in Jacksonville, FL.
Every tooth gets a decision, and every decision has a reason.
Before radiation to the head and neck, your teeth, gums, and jaw need a careful look. Dr. Henley does this evaluation at our San Marco office. He decides tooth by tooth what to keep, what to treat, and what to remove, based on your radiation plan, and sends a written summary to your oncology team.
- 2 weeksof healing after a needed extraction before radiation starts, when it won’t delay treatment1
- 50 Gyor more to the jaw is the dose level guidelines tie to osteoradionecrosis risk1
- 1 monthbefore cancer treatment is the ideal time for the dental evaluation3
- 35 mmor less of mouth opening is a common cutoff for trismus after head and neck cancer treatment4
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Dental clearance before radiation
Why radiation to the head and neck changes the rules for your teeth.
Radiation that treats the cancer also reaches the jawbone, salivary glands, and chewing muscles. Afterward, bone in the high-dose area heals poorly, saliva may drop for good, and the jaw can stiffen. A tooth that could be pulled easily today may be risky to remove later. That’s why the exam comes first.
Guidelines from ISOO-MASCC and the American Society of Clinical Oncology strongly advise a dental assessment before head and neck radiation. The goal is to find teeth that would put you at risk later and to explain that the risk lasts for life.1 Four problems drive most of the decisions we make.
- Osteoradionecrosis (ORN). Jawbone that received a high radiation dose has less blood supply. An extraction or infection there, even years later, can leave bone exposed that won’t heal. Dental surgery, poor oral hygiene, and tobacco all raise the risk.1 Our osteoradionecrosis page goes into more detail.
- Radiation caries. When saliva drops, teeth can decay quickly, often at the gumline and on edges that don’t usually get cavities. Daily prescription-strength fluoride lowers that risk.1,3 See fluoride trays and radiation caries.
- Dry mouth (xerostomia). Radiation near the salivary glands can reduce saliva permanently. Less saliva means more decay, a sore mouth, and trouble with dentures. Read more about dry mouth.
- Trismus. When radiation reaches the jaw joint or chewing muscles, mouth opening can shrink over the following months.5 A stiff jaw makes eating, brushing, and dental care harder. Learn about radiation-induced trismus.
Your radiation oncologist plans and delivers your treatment. Dr. Henley’s job is the mouth: getting it as healthy as possible before radiation, and helping keep it that way afterward.
When to have a pre-radiation dental evaluation
As early as possible, without holding up radiation.
The exam should happen as soon as radiation is being planned. Guidelines recommend that needed extractions happen at least two weeks before radiation starts, but only when that wait won’t delay cancer treatment in a way that hurts tumor control. If the tumor needs treatment now, radiation comes first.1
Radiation is being planned.
This is the right moment to call us. Ideally the dental evaluation happens about a month before treatment starts.3 Referred patients are typically seen within 72 hours.
The evaluation and a tooth-by-tooth plan.
Dr. Henley examines you, reviews any X-rays, and explains which teeth he’d keep, treat, or remove, and why. You get the fee for each step in writing before any treatment.
Extractions first, when they’re needed.
Teeth that need to come out are usually handled early, so the sockets have time to heal. If removing teeth will change how your teeth come together, guidelines advise doing it before your radiation mask is made.1
Fillings, cleaning, and fluoride trays.
Decay is repaired, the gums are cleaned, sharp edges are smoothed, and fluoride trays are made so you can start using them before radiation begins.
Your oncology team gets a written summary.
What was found, what was done, and anything still pending. Then radiation starts on the date your team set.
Pre-radiation dental evaluation
What the exam includes, and what each part tells us.
The evaluation covers your health history and medications, every tooth, your gums and bone, the soft tissues of the mouth, X-rays where they’re needed, and a measurement of how wide you can open. Each piece answers a specific question about how your mouth will handle radiation and the years after it.
- Health history and medications. Your diagnosis, surgery plans, and medications, including blood thinners, steroids, and any bone-modifying drug such as zoledronic acid or denosumab. Some of these change how an extraction should be handled.
- Every tooth. Decay, cracks, old fillings and crowns, and signs of an infected nerve. The question for each: will it stay healthy for years with good care?
- Gums and bone support. Dr. Henley measures the gum pockets around each tooth and checks for looseness. Moderate to severe gum disease in the radiation field is one of the main reasons guidelines advise removal.1
- X-rays. X-rays show decay, infection at the root tips, and bone levels. A panoramic X-ray shows both jaws at once, including wisdom teeth. When a closer look is needed, 3D (CBCT) imaging may help. Recent X-rays from your own dentist are used when available.
- Soft tissues. Cheeks, tongue, palate, and floor of the mouth. Anything unexpected goes to your oncology team.
- Jaw opening and the jaw joint. A baseline measurement of how far you can open, so any loss later can be caught early.
- Dentures, partials, and other appliances. Fit, rough spots, and anything that could rub tissue that will be sore during radiation.2
Dr. Henley sees you himself and walks you through what he finds before anything is decided.
Dental extraction before radiation therapy
Keep, treat, or remove: how each tooth is judged.
No single factor decides. Dr. Henley weighs where the tooth sits relative to the high-dose area, how healthy the gums and bone are, whether it can be repaired well, whether you can keep it clean for life, and what you’ll need to chew. A tooth with a poor outlook in the high-dose area is the clearest case for removal.1
| Factor | Points toward keeping | Points toward treating | Points toward removing |
|---|---|---|---|
| Location and expected jaw dose | Outside the radiation field or in a low-dose area | In the field, but healthy enough to repair now | In the high-dose area with a poor long-term outlook1 |
| Gum and bone support | Healthy gums, normal pocket depths, firm tooth | Mild gum disease that a cleaning can control | Moderate to severe gum disease, deep pockets, or a loose tooth1,2 |
| Restorability | Sound tooth or solid existing work | Decay or a failing filling that can be fixed reliably before radiation | Decay too deep to repair well, or a crack that can’t be restored3 |
| Infection at the root | None on exam or X-ray | Treatable with a root canal when time and the tooth allow | Infection that can’t be resolved before radiation, especially if it has caused symptoms recently2 |
| Wisdom teeth | Fully erupted, cleanable, healthy | — | Partly erupted and in the field, depending on location and healing time1 |
| Your ability to keep it clean | Good home care, able to use fluoride trays daily | Needs help: a new routine, more frequent cleanings | Long-term care unlikely and the tooth is already marginal |
| Chewing and prosthetic plans | Tooth anchors a partial or is key for chewing | Can be kept to support a future denture or partial | Adds risk without adding much function |
These are factors, not a formula. If an extraction is needed, our tooth extraction page explains what to expect.
Working with your radiation oncologist
Your radiation plan shapes the dental plan.
The same tooth can be low risk for one person and high risk for another, depending on how much radiation the jaw around it receives. Guidelines ask radiation oncologists to share the planned field, the expected dose to the upper and lower jaw, and the start date with the dentist.1 That information guides each decision.
Guidelines place ORN risk at a jaw dose of about 50 Gy or more.1 Radiation teams lower the dose to bone where they can without shortchanging the tumor. So our question is which teeth sit in bone that will get a high dose, and whether they’ll stay healthy for life.
What we ask your radiation team for
- Which side and which areas are being treated, and whether the lower jaw, upper jaw, or both are in the field.
- The expected dose to the jaw, when it’s available. Early on it may not be; we plan from what’s known and adjust.
- The start date and when the radiation mask will be made.
- Surgery plans, including whether part of the upper jaw will be removed. Patients facing a maxillectomy may need an obturator; see maxillectomy and obturation.
Dr. Henley is affiliated with Baptist Medical Center Jacksonville and is a member of the Baptist MD Anderson Head and Neck Tumor Board. Care teams can reach him through the physician line at (904) 762-5616 or our physician referrals page.
Teeth before head and neck radiation
Protecting the teeth, jaw, and tissues you keep.
Removing risky teeth is only half the job. The other half is protecting what stays: fluoride trays made before radiation, a baseline jaw-opening measurement with exercises to keep the jaw moving, and a check of any dentures or partials so they don’t rub tissue that will soon be tender.
Custom fluoride trays
Thin trays made from impressions or a scan hold prescription fluoride gel against the teeth for a few minutes each day. Patients at risk of lower saliva are advised to use daily prescription-strength fluoride, and to keep using it.1,3 We aim to have trays ready before radiation begins. More on fluoride trays.
Baseline jaw opening
We measure the distance between your upper and lower front teeth when you open wide. One study of people treated for oral and throat cancers found 35 mm or less was a useful cutoff for trismus.4 Knowing your starting number makes a later change easier to spot.
Jaw exercises
Jaw opening and stretching exercises during and after radiation are recommended to lower the risk of trismus.2,3 Dr. Henley shows you simple ones before treatment starts, while your mouth is still comfortable. See radiation-induced trismus.
Dentures and partials
Appliances that rub can injure tissue that radiation makes fragile.2 We check the fit and smooth rough spots. Your oncology team may tell you when to leave them out. After radiation, dentures sometimes need to be remade because the tissues change.3 See dentures.
When radiation starts soon
What happens if there isn’t time to do everything.
Often the start date is close. When it is, Dr. Henley sorts treatment by risk. Teeth that are infected, hopeless, or in the high-dose area come first. Work that can safely wait does. If the tumor is growing quickly, guidelines say extractions should be deferred rather than delay radiation.1
How risk priority works
- First: teeth in the high-dose area that are unlikely to last, active infection, and anything causing pain.
- Next: decay that can be repaired quickly, a thorough cleaning, and fluoride trays.
- Later: teeth outside the field, replacing missing teeth, and anything cosmetic.
If something can’t be done before radiation, Dr. Henley tells your oncology team what’s still open and how he plans to handle it. A tooth left in place isn’t a failure. In high-risk areas after radiation, guidelines favor saving a tooth with a root canal, crown, or filling over removing it when that’s reasonable.1
The start date belongs to your oncology team. We plan around it. If you’re traveling to Jacksonville for treatment, our page on dental care for cancer treatment covers scheduling, what to bring, and going home.
After the pre-radiation exam
The written summary, and what follows during and after radiation.
Your oncology team gets a written summary from Dr. Henley: findings, treatment completed, anything pending, and the prevention plan. Care continues during radiation for comfort and problems that come up, and long term for decay prevention, jaw opening, and careful handling of any tooth in the high-dose area.
The summary to your oncology team.
It lists teeth removed or treated, healing status, anything deferred and why, fluoride trays delivered, and your baseline opening.
During radiation.
Mouth sores and dry mouth are common. We help keep your mouth clean and comfortable and adjust appliances. Your oncology team manages the medical side.
The first months after.
We recheck teeth, gums, and jaw opening. Cleanings are usually more frequent than before.
For life.
The ORN risk doesn’t go away.1 Tell every future dentist about your radiation, and keep a copy of your radiation summary. Dental care never replaces your oncology follow-up.
Dental exam before radiation in Jacksonville
Cost, insurance, and where we are.
Our office is at 3675 Hendricks Avenue in San Marco, near downtown Jacksonville. We don’t bill medical insurance, and we’re an out-of-network dental office. Cost depends on what the exam finds and how much must be done before your start date. You’ll get the fee for each step in writing first.
Many dental plans still pay part of the cost, and our team can help you understand how to use your benefits. You’re responsible for what your plan doesn’t pay. Call 904.398.1549 with your plan details to ask about fees and payment arrangements, or see dental insurance and payment.
Frequently asked questions
Questions about the dental exam before radiation.
Where can I get a dental exam before radiation in Jacksonville?
Dr. Henley does pre-radiation dental evaluations at our San Marco office, 3675 Hendricks Avenue. Referred patients are typically seen within 72 hours. Call 904.398.1549, or have your oncology team use our physician referrals page or the physician line at (904) 762-5616.
What is dental clearance before radiation?
It means a dentist has examined your mouth, found teeth likely to cause trouble after radiation, and either treated them or made a plan your oncology team knows about. It isn’t a pass or fail. It’s a record of what was found and done, so radiation can start with as little dental risk as possible.
Do all my teeth have to come out before radiation?
No. Removal is for teeth with a poor long-term outlook, especially in the high-dose area. Healthy teeth are kept and protected with daily fluoride and good home care. Each tooth gets its own decision based on your exam and radiation plan.
How long before radiation should extractions happen?
Guidelines recommend at least two weeks of healing between an extraction and the start of radiation, as long as that doesn’t delay cancer treatment in a way that affects tumor control. If radiation needs to start right away, it does, and the dental plan is adjusted around it.
Will the exam delay my radiation?
It shouldn’t. Your oncology team sets the start date, and we plan around it. When time is short, Dr. Henley handles the highest-risk teeth first and tells your team what’s still pending. Calling as soon as radiation is planned gives us the most room.
Do I need fluoride trays if my teeth are healthy?
Usually, yes, if radiation is likely to reduce your saliva. Healthy teeth can decay quickly without saliva. Daily prescription fluoride in custom trays helps protect them, and it’s generally advised for the long term. Having trays ready before radiation lets you start on time. See fluoride trays.
Why do you measure how wide I can open?
Radiation can stiffen the jaw muscles and joint over the months after treatment. A baseline measurement before radiation makes any loss easier to notice early, when exercises tend to help most. Dr. Henley also shows you simple jaw exercises to start before treatment.
Can I keep wearing my dentures or partial during radiation?
Sometimes, but tissue gets tender during radiation, and an appliance that rubs can make sores worse. We check the fit and smooth rough spots before treatment. Your oncology team may advise leaving it out at times. Dentures sometimes need to be remade after radiation.
What if a tooth needs to come out after radiation?
Tell the dentist about your radiation first. In high-dose areas, saving the tooth with a root canal, crown, or filling is often preferred. If removal is needed, it’s planned with your radiation history and the dose to that area in mind. Read about osteoradionecrosis.
Does a dental exam replace my cancer follow-up?
No. Dr. Henley is a general dentist. Your oncology team diagnoses and treats the cancer and handles your follow-up. His role is your teeth, gums, and jaw before, during, and after radiation. Learn more on our head and neck cancer page.
Your next step
Call as soon as radiation is on the calendar.
The earlier we see you, the more room there is to heal. Tell us your start date when you call. Care teams can reach Dr. Henley through the physician line at (904) 762-5616, by fax at (904) 212-4045, or through our physician referrals page.
CJ Henley, DMD, PA3675 Hendricks Avenue
Jacksonville, FL 32207
Prefer a nonurgent text? 904.762.5616 is our practice on-call and text line. Please don’t send sensitive health information by text, and call for anything urgent.
Related pages
Sources
- Peterson DE, Koyfman SA, Yarom N, et al. Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline. J Clin Oncol. 2024;42(16):1975-1996.
- PDQ Supportive and Palliative Care Editorial Board. Oral Complications of Cancer Therapies (PDQ®)–Health Professional Version. National Cancer Institute.
- National Institute of Dental and Craniofacial Research. Oral Complications of Cancer Treatment: What the Dental Team Can Do. National Institutes of Health.
- Dijkstra PU, Huisman PM, Roodenburg JLN. Criteria for trismus in head and neck oncology. Int J Oral Maxillofac Surg. 2006;35(4):337-342.
- Dijkstra PU, Kalk WWI, Roodenburg JLN. Trismus in head and neck oncology: a systematic review. Oral Oncol. 2004;40(9):879-889.