Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Dental pathologies and osteoradionecrosis (Part 1) literature review and consensus statement

• Ten clusters of statements had consensus from a multidisciplinary international expert panel on the management of dental problems and osteoradionecrosis (ORN) in head and neck cancer patients (HNCPs).
• Before chemo-radiotherapy: general statements, risk factors, assessment tools, and preventive hygiene of oral cavity.
• During chemo-radiotherapy: statements about recommended, no recommended, suggested and no-suggested practice to manage dental problems and ORN in HNCPs.
• Statements about the radiotherapic precautions to be adopted in order to reduce the risk of radioinduced dental problems and ORN in HNCPs.

Radiotherapy alone or in combination with chemotherapy and/or surgery is the typical treatment for head and neck cancer patients. Acute side effects (such as oral mucositis, dermatitis, salivary changes, taste alterations, etc.), and late toxicities in particular (such as osteo-radionecrosis, hypo-salivation and xerostomia, trismus, radiation caries etc.), are often debilitating. These effects tend to be underestimated and insufficiently addressed in the medical community.A multidisciplinary group of head and neck cancer specialists met in Milan with the aim of reaching a consensus on clinical definitions and management of these toxicities.The Delphi Appropriateness method was used for developing the consensus, and external experts evaluated the conclusions. This paper contains 10 clusters of statements about the clinical definitions and management of head and neck cancer treatment sequels (dental pathologies and osteo-radionecroses) that reached consensus, and offers a review of the literature about these topics.The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecroses (10 clusters of statements), whereas this second part deals with trismus and xerostomia.