Osteoradionecrosis Risk — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementOsteoradionecrosis RiskORE Part 1

A 65-year-old woman with a history of radiotherapy to the head and neck for a previous laryngeal carcinoma requires dental extractions. She completed radiotherapy 18 months ago. What is the key dental concern?

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Correct answer: C — Risk of osteoradionecrosis (ORN) of the jaws

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · B = shown as D · C = shown as E

Osteoradionecrosis (ORN) is the key concern. Following head and neck radiotherapy, patients carry a lifelong risk of ORN when teeth are extracted, particularly mandibular teeth. Dental extraction in irradiated bone is one of the most significant trigger factors for ORN development. This is why UK guidance (NHS, CUH) recommends specialist referral for extraction after radiotherapy and extraction of 'at-risk' teeth before radiotherapy commences. Option B (MRONJ) is incorrect because MRONJ is medication-related osteonecrosis associated with bisphosphonates, denosumab, or anti-angiogenic agents, and its diagnostic criteria explicitly exclude radiation-induced osteonecrosis. There is no mention in the stem of bisphosphonate or denosumab use. Options C, D, and E, while possible post-radiotherapy complications, are not the primary dental concern specific to tooth extraction in this scenario.

Reference: NHS Specialist Pharmacy Service & Cambridge University Hospitals NHS Foundation Trust: Dental management in head and neck radiotherapy patients (2026); supported by Osteoradionecrosis after treatment of head and neck cancer: a comprehensive analysis (2021), https://www.sps.nhs.uk/articles/how-should-adults-with-cancer-be-managed-by-general-dental-practitioners-if-they-need-dental-treatment/