# Dental X-Rays and Scans After Head and Neck Radiotherapy: What Patients Need to Know

A new review examines whether dental X-rays and scans are safe for people who are currently receiving, or have recently finished, radiotherapy for head and neck cancer. Radiotherapy is essential for curing these tumors, but it damages sensitive tissues in the mouth, including the mucosal lining, salivary glands, and jawbone. Dental imaging delivers radiation doses thousands of times lower than treatment doses, yet the authors found that the biological effects of these small extra doses on already-irradiated tissue remain largely unstudied. Their conclusion: imaging should never be withheld when it is clinically necessary, but every X-ray should be justified, carefully timed, and performed with optimized low-dose protocols.

# Dental X-Rays and Scans After Head and Neck Radiotherapy: What Patients Need to Know

## Table of Contents

- Key Points
- Why This Review Matters
- How the Review Was Conducted
- The Oral Structures Most at Risk
- Cancers of the Mouth and Throat
- How Radiotherapy Affects the Mouth and Throat
- What Radiation Does Inside the Cells
- Why Follow-Up Imaging Must Continue
- Could Low-Dose Dental Imaging Add to the Damage?
- Comparing Dental X-Ray Doses With Radiotherapy Doses
- Protective Approaches and Safety Strategies
- What This Means for Patients
- What the Review Could Not Answer
- Practical Recommendations
- Frequently Asked Questions
- Source Information

## Key Points

- No clinical evidence shows dental X-rays, panoramic imaging, or CBCT cause or increase osteoradionecrosis in previously irradiated bone.
- Dental imaging doses are thousands of times lower than radiotherapy doses, but their biological effects on irradiated tissue remain largely unstudied.
- Imaging should never be withheld when clinically necessary, but every X-ray should be justified, carefully timed, and performed with optimized low-dose protocols.
- The American Head and Neck Society recommends follow-up examinations every 1 to 3 months during the first year after radiotherapy.
- Report pain, exposed bone, swelling, pus, or restricted jaw opening promptly, and tell every provider about your radiation history.

## Why This Review Matters

Radiotherapy has dramatically improved survival for people with head and neck cancer, but it comes at a cost. Ionizing radiation (high-energy beams that can damage cells) does not distinguish between tumor and healthy tissue. It causes both acute (short-term) and late (long-term) toxicities in the mouth and face — specifically the lower jawbone (mandible), the mucosal lining, the salivary glands, and the teeth.

Because of these changes, patients need ongoing dental and maxillofacial imaging (imaging of the teeth, jaws, and face) for diagnosis, treatment planning, and rehabilitation. In everyday practice, intraoral radiographs (small X-rays taken inside the mouth) and panoramic radiographs (a single image showing all teeth and both jaws) are used to check for cavities, gum disease, and root canal problems. Cone-beam computed tomography (CBCT — a three-dimensional X-ray scan) is used to assess bone quality, detect abnormalities, plan dental implants, or look for suspected osteoradionecrosis (ORN — death of bone tissue caused by radiation).

Here is the problem. Despite the clear diagnostic value of these scans, no one has carefully studied whether they are biologically safe in patients who are still receiving, or have recently completed, radiotherapy. The review asks three questions:

1. How much extra radiation do dental scans actually add?
1. Is there a plausible biological reason these small doses could matter?
1. What practical and ethical rules should guide safe imaging in cancer patients?

Radiotherapy and radiology both use ionizing radiation, but they are very different in intent. Radiotherapy delivers therapeutic doses designed to destroy tumor DNA and trigger cell death. Dental radiology operates at the milligray level (thousands of times lower) with the goal of gathering diagnostic information at minimal exposure.

The catch is that previously irradiated tissue is not normal tissue. Bone, mucosa, and salivary glands in the treatment field have reduced blood supply, fewer cells, and a weaker capacity to repair damage. This means they may be more vulnerable than healthy tissue, even to low-dose exposures. The authors raise an important question: do the usual safety assumptions behind diagnostic imaging still fully apply during or soon after radiotherapy?

The growing use of high-resolution imaging, especially CBCT and digital panoramic systems, has improved diagnostic precision. But it has also renewed debate about cumulative radiation exposure, particularly in younger patients and long-term cancer survivors. Only a few studies have tried to measure these additive effects or propose imaging protocols designed specifically for this group. Bridging that gap, the authors argue, requires dental radiologists, radiation oncologists, and medical physicists to work together.

## How the Review Was Conducted

The authors performed a narrative literature review (a structured summary and interpretation of existing published research). They searched PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2000 and 2025. That window covers the modern era of radiotherapy and contemporary dental imaging technology. Only English-language publications were included.

Search terms combined anatomical descriptions of the mouth and jaw with concepts such as radiotherapy-induced toxicity, diagnostic imaging dose, cone-beam computed tomography, panoramic radiography, radiobiological effects, radioprotection, and cumulative exposure.

The initial search returned approximately 500–600 records. After screening titles and abstracts for relevance to imaging performed during or after head and neck radiotherapy, the authors selected around 150–180 articles for full-text review. From these, roughly 70–80 studies were included in the final synthesis.

Studies were excluded if they focused only on non-ionizing imaging (such as ultrasound or MRI), were unrelated to the head and neck region, consisted only of single case reports, or lacked biological or dosimetric relevance to irradiated tissue. The authors also reviewed the reference lists of key articles to make sure coverage was complete. This approach allowed them to blend experimental, dosimetric, radiobiological, and clinical evidence into one coherent picture.

## The Oral Structures Most at Risk

Understanding the anatomy of the mouth and jaw is essential for interpreting radiation damage and planning safe imaging. Two structures are the most radiosensitive (most easily damaged by radiation) in the treatment field: the oral mucosa and the alveolar bone (the bone that holds the teeth).

The oral mucosa is made of stratified squamous epithelium (a layered, flat-celled surface lining) sitting on a connective tissue layer called the lamina propria. It is highly proliferative, meaning its cells divide quickly — which also makes it quick to show radiation injury. During radiotherapy, direct DNA damage and inflammation of small blood vessels cause the epithelium to thin, turn red (erythema), and ulcerate. The result is oral mucositis (painful inflammation and ulceration of the mouth lining), a common acute toxicity that can affect nearly all patients treated for head and neck tumors.

Beneath the mucosa, the upper jaw (maxilla) and lower jaw (mandible) form the bony framework of the mouth. These bones are critical for dental and prosthetic rehabilitation. The mandible is especially susceptible to radiation damage because it has dense cortical bone (the hard outer layer) and relatively poor blood supply compared with the maxilla.

Alveolar bone and periodontal tissues (the structures that support teeth) act as a functional unit, providing tooth support, blood supply, and mechanical stability. Radiation disrupts this balance in three ways: it causes collagen cross-linking (stiffening of the protein scaffolding in bone), reduces cell turnover, and lowers the activity of osteoblasts (bone-building cells). These changes appear on imaging as bone demineralization (loss of mineral content), trabecular rarefaction (thinning of the spongy inner bone), and cortical discontinuity (breaks in the hard outer layer). CBCT detects these changes most precisely and can reveal altered bone density and tiny structural defects early.

Radiation also damages the salivary glands. When they under-function, the resulting dry mouth (xerostomia) makes the mucosa more fragile and increases the risk of radiation caries (aggressive tooth decay caused by radiation). These cavities tend to form on the smooth and cervical surfaces of teeth — the sides and the gum-line areas. Reduced salivary buffering capacity and thinner saliva also shift the balance of the oral microbiome (the community of bacteria and fungi in the mouth), which further promotes mineral loss from teeth.

## Cancers of the Mouth and Throat

Radiotherapy remains a cornerstone of treatment for head and neck malignancies, especially squamous cell carcinomas (SCCs — cancers arising from the flat, scale-like cells that line the mouth and throat). Together, cancers of the oral cavity and oropharynx (the middle part of the throat behind the mouth) account for most epithelial tumors in this region and share overlapping risk factors and treatment approaches.

### Oral Squamous Cell Carcinoma (OSCC)

The oral cavity includes the lips, tongue, floor of the mouth, oral mucosa, alveolar ridge, and hard palate. It is the site of origin for about **90–95% of head and neck squamous cell carcinomas**. These tumors start in the stratified squamous epithelium, often after long-term exposure to carcinogens such as tobacco and alcohol, poor oral hygiene, and mechanical irritation. Human papillomavirus (HPV) infection plays a smaller role in oral cancer than it does in throat cancer.

Treatment depends on the stage and location of the tumor. Early-stage disease (T1–T2, N0 — small tumors with no lymph node involvement) is usually treated with surgery, followed by adjuvant radiotherapy (additional radiation after surgery) if high-risk features are found under the microscope. Locally advanced or inoperable tumors are treated with definitive radiotherapy or concurrent chemoradiotherapy (radiation given at the same time as chemotherapy), typically delivering **66–70 Gy** (gray — a unit of absorbed radiation dose) to the primary tumor and involved lymph nodes.

Intensity-modulated radiotherapy (IMRT) and image-guided techniques allow precise targeting while minimizing dose to critical oral structures such as the mucosa, salivary glands, and mandible. Even so, complications such as mucositis, xerostomia, radiation caries, and osteoradionecrosis remain significant. Managing them requires close collaboration between radiation oncologists and dental specialists.

### Oropharyngeal Squamous Cell Carcinoma (OPSCC)

The oropharynx includes the base of the tongue, soft palate, tonsillar region, and posterior pharyngeal wall. Unlike oral cancer, HPV-related carcinogenesis is now the dominant pathway in oropharyngeal cancer, particularly in younger, non-smoking individuals. These HPV-positive tumors typically overexpress a protein called p16 and have a better prognosis and greater sensitivity to radiation than HPV-negative tumors.

Treatment strategy depends on HPV status, tumor stage, and the patient's other medical conditions. For HPV-negative or locally advanced disease, definitive concurrent chemoradiotherapy is standard, with doses around **70 Gy** to the main tumor and involved lymph nodes. Because HPV-positive tumors respond so well, they are the subject of ongoing de-escalation trials — studies testing reduced-dose regimens or minimally invasive surgery followed by adjuvant radiotherapy — with the goal of preserving function while maintaining high cure rates.

From a biological standpoint, oropharyngeal tumors sit very close to radiosensitive structures such as the base of the tongue, soft palate, and salivary glands. This proximity demands meticulous dose planning. Advanced techniques including chemoradiotherapy and proton therapy help spare these organs at risk, reducing long-term side effects such as difficulty swallowing (dysphagia), dry mouth, and altered taste.

## How Radiotherapy Affects the Mouth and Throat

Radiation's effects on normal tissue depend on the total dose, how it is divided into fractions, and which structures fall inside the radiation field. Within the oral cavity, the most radiosensitive structures are the oral mucosa, salivary glands, and alveolar bone.

Modern delivery techniques have improved significantly. IMRT and volumetric modulated arc therapy (VMAT) produce highly conformal dose distributions — meaning the radiation dose is shaped to match the tumor — with better sparing of the salivary glands, mandible, and chewing muscles compared with older three-dimensional conformal techniques. Image-guided radiotherapy (IGRT) adds daily verification and adaptive adjustments to treatment planning, improving precision further.

Specific dose thresholds matter for patients:

-
**20–30 Gy:** damages epithelial and salivary tissue, causing mucositis — the earliest and most common acute toxicity. Symptoms include redness, pseudomembranous ulceration (white-yellow patches of dead tissue), pain, and difficulty swallowing. These lesions arise from epithelial cell death and the release of inflammatory cytokines (signaling molecules that drive inflammation). Severity correlates with total dose and concurrent chemotherapy.
-
**40–65 Gy:** causes salivary gland atrophy, leading to xerostomia and hyposalivation (reduced saliva production). Patients develop thick, viscous saliva, cracked lips, and altered taste (dysgeusia). Reduced salivary flow causes radiation caries, which can appear within weeks of therapy, plus secondary infections — particularly candidiasis (thrush) and herpes lesions. These problems are often accompanied by nutritional deficiency and psychological distress from painful oral function.
-
**Above 60 Gy:** risk of osteoradionecrosis, a late complication. The mandible is the most affected site because of its dense structure and limited blood supply. ORN appears as exposed dead bone, pain, pus formation, and sometimes a fistula (abnormal opening) or pathological fracture. Risk factors include poor oral hygiene, tobacco and alcohol use, and dental extractions after radiation therapy.

Another common late effect is trismus — limited jaw opening caused by scarring (fibrosis) of the chewing muscles. It usually appears three to six weeks after treatment ends and can interfere with oral hygiene and nutrition.

**One crucial point:** to date, no clinical evidence shows that dental and maxillofacial radiology — whether intraoral X-rays, panoramic imaging, or CBCT — causes or increases the risk of osteoradionecrosis in previously irradiated bone. ORN is primarily linked to high-dose therapeutic radiation, local trauma, infection, and poor blood supply, not to the very small extra doses from diagnostic imaging. In fact, imaging plays an essential role in diagnosing, staging, and monitoring ORN and is indispensable for planning preventive and therapeutic interventions.

In the oropharynx, radiation causes inflammation and fibrosis in the base of the tongue, soft palate, and tonsillar region. This leads to difficulty swallowing, taste changes, and speech alterations. Opportunistic infections can also arise because of immune suppression. All of these complications highlight the need for early dental evaluation, continuous oral care, and close interdisciplinary management.

## What Radiation Does Inside the Cells

Radiation causes structural and molecular changes to the oral mucosa that compromise its integrity and its ability to regenerate. At the tissue level, ionizing radiation produces epithelial atrophy (thinning), blood vessel damage, and inflammation. Early signs such as redness and swelling often progress to mucositis, ulceration, and secondary infections. Importantly, the drop in cell division happens *before* any visible mucosal lesion appears — cellular depletion comes first.

At the ultra-structural level, a study by Asikainen and colleagues used scanning and transmission electron microscopy (powerful microscopes that reveal fine cellular detail) to examine irradiated mucosa. They found that radiation disrupts epithelial microplicae (MPL) — tiny ridges on the cell surface that support the salivary pellicle (a protective saliva-derived film) and act as a barrier against microorganisms. Patients showed partial or total loss of MPL and of desmosomal junctions (the "spot welds" that hold epithelial cells together), along with blistering of epithelial cells and widening of the spaces between cells. These changes were particularly pronounced in patients who later developed osteoradionecrosis. In other words, destruction of the mucosa's microscopic architecture weakens the epithelial barrier, which may allow microbial invasion and impair healing in irradiated bone and soft tissue.

At the molecular level, radiation-induced oral mucositis involves a complex interplay between inflammatory signaling, oxidative stress (damage from unstable oxygen molecules), and impaired repair pathways. According to Saul-McBeth and colleagues, radiation activates the NF-κB, IL-1, and IL-17 signaling cascades. These pathways amplify the release of pro-inflammatory cytokines such as IL-6 and TNF-α, and matrix metalloproteinases (MMP-3, MMP-9, MMP-10 — enzymes that break down the tissue scaffolding). The result is degradation of the extracellular matrix and delayed mucosal repair.

In mouse models, deficiency of the IL-17 receptor (IL-17RA) markedly worsened oral mucositis, producing deeper ulcers, more neutrophil infiltration (an influx of immune cells), and higher oxidative stress. Conversely, intact IL-17 signaling protected mucosal integrity by promoting epithelial proliferation (measured by Ki-67 expression), production of keratinocyte growth factor (KGF), and secretion of tissue-repair mediators such as IL-24 and MMP-3.

These mechanisms explain the path from acute inflammation to chronic injury. First, DNA damage and accumulation of reactive oxygen species (ROS) cause basal epithelial cells to die. Next, loss of the mucosal barrier exposes underlying connective tissue, triggering an inflammatory cascade that perpetuates pain, ulceration, and infection. Without adequate epithelial regeneration or immune balance, chronic low oxygen levels and impaired blood vessel growth contribute to late complications such as fibrosis and osteoradionecrosis.

The authors note that understanding these mechanisms provides a biological basis for developing targeted therapies — including anti-inflammatory cytokine modulators, antioxidant treatments, and epithelial growth factor analogues — to reduce mucosal toxicity and improve healing after radiation.

## Why Follow-Up Imaging Must Continue

Radiographic and clinical examinations should never be skipped after head and neck cancer treatment. International guidelines stress that early detection of recurrence, metastasis, and treatment-related complications depends on frequent follow-up visits. The American Head and Neck Society recommends examinations every **1 to 3 months during the first year** after radiotherapy, because most recurrences occur within that window and delayed diagnosis significantly worsens prognosis.

Beyond cancer surveillance, dental imaging plays an essential role in managing the dental health of irradiated patients. Radiotherapy significantly raises the risk of radiation caries, hyposalivation, altered pulp sensitivity, apical periodontitis (infection around the root tip), and osteomyelitis of the jaw (bone infection). Radiographic assessment is therefore indispensable for determining how deep a lesion goes, how close it is to the pulp (the tooth's nerve center), and the status of the tissue around the root tip.

In complex root canal cases, CBCT provides superior three-dimensional visualization. It reduces the likelihood of missed canals, perforations, or inadequate cleaning — all of which are known risk factors for osteoradionecrosis and post-radiotherapy infections.

Bottom line: imaging remains a key element of safe, effective dental care in this vulnerable population. It should be performed with optimized protocols — but it should never be withheld when clinically indicated.

## Could Low-Dose Dental Imaging Add to the Damage?

Dental and maxillofacial imaging delivers radiation doses several orders of magnitude lower than therapeutic radiotherapy. Even so, the authors argue that its biological effects deserve careful thought in patients currently undergoing or recently completing head and neck radiotherapy.

Two factors raise concern. First, the anatomical regions overlap — dental imaging targets the exact same structures that radiotherapy already damaged. Second, the micro-environment of irradiated tissue is altered, with reduced repair capacity and persistent low-grade inflammation. Together, these factors could theoretically produce additive or synergistic effects, even when each individual imaging dose is minimal.

The mechanisms proposed are oxidative and inflammatory. Repeated low-dose exposures during or shortly after radiotherapy might biologically amplify ongoing or latent radiation injuries by adding to oxidative stress and inflammatory signaling.

## Comparing Dental X-Ray Doses With Radiotherapy Doses

Individually, intraoral, panoramic, and CBCT scans all deliver very low doses of ionizing radiation. However, their timing relative to radiotherapy — and the cumulative exposure of radiosensitive oral tissues — may influence local biological responses.

The review includes two comparison tables that lay out the dose gap clearly.

-
**Table 1** classifies dentomaxillofacial imaging modalities by effective dose (measured in microsieverts, µSv) and by how that compares with natural background radiation. For example, intraoral periapical and bitewing radiographs deliver **0.3–1.4 µSv**, which is less than one day of background radiation (marked as "<1 day Bk").
-
**Table 2** summarizes estimated organ doses delivered during common dental imaging procedures and compares them with the typical therapeutic exposures those same tissues receive during head and neck radiotherapy.

The therapeutic dose of radiotherapy — **60–70 Gy** — far exceeds any diagnostic exposure. A single gray is one million microsieverts, so the difference is enormous. Yet the authors emphasize that this comparison alone does not settle the question, because dental imaging targets the very structures already compromised by treatment.

## Protective Approaches and Safety Strategies

The review highlights several strategies intended to reduce unnecessary exposure while preserving diagnostic quality:

-
**Justification** — every X-ray must have a clear clinical reason. No routine imaging "just in case."
-
**Timing** — scheduling imaging thoughtfully relative to the radiotherapy course and the healing timeline.
-
**Protocol optimization** — using low-dose acquisition protocols tailored to the clinical question.
-
**Dose modulation** — adjusting exposure settings to the minimum needed for a diagnostic image.
-
**Field limitation** — restricting the radiation field to the smallest area that answers the clinical question.
-
**Modern low-dose technologies** — including optimized CBCT acquisition protocols, iterative reconstruction algorithms (mathematical methods that produce clear images from less data), pulsed exposure systems, and AI-assisted dose modulation.

These imaging advances parallel improvements in radiotherapy delivery itself. IMRT, VMAT, and IGRT all reflect the same contemporary standard: precision, tissue preservation, and radiation protection. Integrating modern techniques into routine practice is essential for aligning therapeutic precision with biologically informed imaging.

## What This Means for Patients

The central message is reassuring but practical. Dental X-rays and scans do not appear to cause osteoradionecrosis, and they are essential for detecting decay, infection, and bone complications in irradiated jaws. Withholding them would be more dangerous than performing them.

At the same time, radiation-treated tissue is fragile. The mucosa, salivary glands, and mandible have less blood supply, fewer dividing cells, and weaker repair capacity. That makes each additional exposure worth a second thought — not because it is known to cause harm, but because the evidence base is thin and caution costs little.

Patients should expect their care team to justify each image, choose the lowest-dose technique that will answer the question, and time the scans sensibly around treatment and healing. When a clinician orders a CBCT, it is usually because the three-dimensional detail will change what happens next — for example, by preventing a missed root canal or catching bone changes early.

## What the Review Could Not Answer

This is a narrative review, not a clinical trial. It synthesizes existing evidence rather than generating new data. Several gaps remain:

- Very few studies have directly quantified the additive biological effects of low-dose dental imaging on previously irradiated tissue.
- Evidence-based imaging protocols designed specifically for this population are largely absent.
- Much of the mechanistic evidence — such as the IL-17 and MPL findings — comes from animal models or small ultrastructural studies, not large human trials.
- The review cannot establish a safe cumulative dose threshold for diagnostic imaging in irradiated patients, because no such threshold has been defined in the literature.

The authors call for multidisciplinary collaboration among dental radiologists, radiation oncologists, and medical physicists to close these gaps.

## Practical Recommendations

1.
**Never skip clinically indicated imaging.** Follow-up examinations and radiographs protect you from undetected recurrence, decay, and bone infection.
1.
**Keep up with follow-up visits.** The American Head and Neck Society recommends examinations every 1 to 3 months during the first year after radiotherapy.
1.
**Ask about dose optimization.** Your imaging team should use the lowest-dose protocol that still gives a diagnostic image.
1.
**Tell every provider about your radiation history.** This includes dentists, radiologists, and any specialist ordering a scan of the head or neck.
1.
**Prioritize oral hygiene.** Poor oral hygiene, tobacco, and alcohol raise the risk of osteoradionecrosis and dental extractions after radiation.
1.
**Report symptoms early.** Pain, exposed bone, swelling, pus, or restricted jaw opening should be evaluated promptly.
1.
**Coordinate your care.** Dental and radiation oncology teams should communicate about timing, especially before any extraction or surgery in the treated area.

## Frequently Asked Questions

### Are dental X-rays safe if I'm having or just finished radiotherapy for head and neck cancer?

No clinical evidence shows dental X-rays, panoramic imaging, or CBCT cause or increase osteoradionecrosis in previously irradiated bone. However, the review found the biological effects of these small extra doses on already-irradiated tissue remain largely unstudied. Imaging should never be withheld when clinically necessary, but each X-ray should be justified, carefully timed, and performed with optimized low-dose protocols.

### Why do I still need dental X-rays and scans after head and neck radiotherapy?

Follow-up imaging is essential because radiotherapy raises the risk of radiation caries, reduced saliva, apical periodontitis, and jawbone infection. Radiographs show how deep a lesion goes, how close it is to the pulp, and the tissue around the root tip. CBCT gives three-dimensional views for complex root canals, helping avoid missed canals or perforations that are known risk factors for osteoradionecrosis.

### How much radiation do dental X-rays add compared with my radiotherapy?

Intraoral periapical and bitewing radiographs deliver 0.3–1.4 microsieverts, less than one day of natural background radiation. Radiotherapy doses are 60–70 gray, and one gray equals one million microsieverts, so the difference is enormous. Even so, the review notes this comparison alone does not settle safety, because dental imaging targets the same structures radiotherapy already damaged.

### Could these small extra doses of radiation damage my mouth or jaw further?

The review says this is theoretically possible but not proven. Two factors raise concern: dental imaging targets the exact structures radiotherapy already damaged, and irradiated tissue has reduced repair capacity and persistent low-grade inflammation. Repeated low-dose exposures during or shortly after radiotherapy might add to oxidative stress and inflammatory signaling, but very few studies have directly measured any additive biological effects.

### What should I expect my care team to do to keep dental imaging safe?

Expect each X-ray to have a clear clinical reason, with no routine imaging just in case. Your team should choose the lowest-dose technique that answers the question, limit the radiation field, and time scans sensibly around treatment and healing. Modern options include optimized CBCT protocols, iterative reconstruction, pulsed exposure, and AI-assisted dose modulation. Tell every provider, including dentists and radiologists, about your radiation history.

### What symptoms after radiotherapy should I report promptly?

Report pain, exposed bone, swelling, pus, or restricted jaw opening promptly for evaluation. These can signal osteoradionecrosis, a late complication appearing above 60 gray, or other problems. Also watch for dry mouth, thick saliva, cracked lips, altered taste, and aggressive tooth decay, which can appear within weeks of therapy. Early reporting helps your dental and radiation oncology teams coordinate care and avoid extractions after radiation.

### How often should I have follow-up examinations after head and neck radiotherapy?

The American Head and Neck Society recommends examinations every 1 to 3 months during the first year after radiotherapy, because most recurrences occur within that window and delayed diagnosis significantly worsens prognosis. Beyond cancer surveillance, these visits support dental health, since radiotherapy raises the risk of decay, infection, and bone complications. Never skip clinically indicated imaging; it protects you from undetected recurrence, decay, and bone infection.

### Should I get a second opinion on whether dental X-rays and CBCT scans are safe after head and neck radiotherapy?

A second opinion can help when you are unsure whether a dental X-ray, panoramic image, or CBCT is justified during or soon after head and neck radiotherapy. Imaging should never be withheld when clinically necessary, but each exposure should have a clear reason, be timed sensibly around treatment and healing, and use a low-dose protocol. No evidence shows dental imaging causes osteoradionecrosis, yet the additive biological effects on already-irradiated tissue remain largely unstudied. An independent review of your imaging plan and radiation history can clarify these trade-offs. Diagnostic Detectives Network provides independent expert second opinions.

## Source Information

**Original article title:** Head and Neck Radiotherapy and Dentomaxillofacial Diagnostic Imaging: Biological Interactions and Protective Approaches.

**Authors:** Fuziama CDH, Borges-Oliveira AC, Santos LF, Lopes SLPC, Costa ALF.

**Affiliations:** Postgraduate Program in Dentistry, Dentomaxillofacial Radiology and Imaging Laboratory, Cruzeiro do Sul University (UNICSUL), São Paulo, Brazil; Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Department of Diagnosis and Surgery, The Institute of Sciences and Technology of São Paulo State University (UNESP), São José dos Campos, Brazil; Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil

**Publication:** *Biomedicines*, 2025, Volume 13, Article 3046. Published 11 December 2025. DOI: https://doi.org/10.3390/biomedicines13123046

**Article type:** Review. Received 20 November 2025; revised 3 December 2025; accepted 9 December 2025.

**Keywords:** head and neck squamous cell carcinoma; oral mucositis; precision oncology; radiation injury; radiobiology

*This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and does not replace personalized medical advice. Patients should discuss their individual imaging and dental care needs with their oncology and dental teams.*


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