Tratamento periodontal em pacientes de risco para osteorradionecrose.

Abstract

Osteoradionecrosis is a complication resulting from radiotherapy treatment used in head and neck cancer, which affects the periodontium, the set of oral structures responsible for supporting the teeth and protecting against pathogenic microorganisms. When these structures undergo an inflammatory process, periodontal disease is characterized, manifesting as clinical attachment loss, periodontal pocket formation, and gingival bleeding on probing, among other signs. These manifestations are aggravating risk factors for the development of ORN (osteoradionecrosis). Radiotherapy, which uses radiation to eliminate cancerous cells, constitutes an important risk factor for osteoradionecrosis, a condition that directly affects the periodontium, compromising the supporting structures, especially when exposed to high doses of radiation. Osteoradionecrosis is characterized by intense pain, dysphagia, malnutrition, and may present with fistulas, ulcers, devitalized bone exposure, bleeding, and delayed healing. Therapeutic intervention involves the use of less invasive procedures and, in severe cases, requires invasive procedures. This study aimed to present periodontal management interventions in patients with the potential to develop osteoradionecrosis, as well as to show the effects of radiotherapy on the periodontium and also the etiology and complications of osteoradionecrosis. The methodology consisted of a literature review conducted through searches in the PubMed, Portal de Periódicos da CAPES and SciELO databases, using articles published between 2015 and 2025. The results indicated that periodontal treatment in irradiated patients should prioritize preventive and minimally invasive approaches (biofilm control, use of fluoride and chlorhexidine solutions, systemic antimicrobials, and ultrasound) to stabilize oral health and mitigate the risk of ORN. It is concluded that invasive procedures, such as tooth extractions and bone resections, should be reserved as a last resort, after conservative therapies have failed, given the fragility of irradiated tissue.