Will you wait to simulate, or resimulate, a patient after teeth extractions in preparation for HN cancer treatment?

The answer is, it depends.

I do not have a specific policy, and it depends refers to which and how many teeth need to be extracted.

The main questions to answer this question are:

1. Will the extractions alter the set up?
2. And as a corollary, will the extractions alter the use of an intraoral device?
3. And finally, if the above are no, will the extractions affect the dosimetry? In general, if the setup is unaltered, the extractions are usually minimal and shouldn't alter the dosimetry, but a simple v...

If the patient has dental extractions done between initial RT simulation and RT start date, I rely on the cone beam CT done during the first fraction to decide whether or not I need to do a re-simulation.

In case the anatomy is lining up well on the CBCT, which is usually the case, I go ahead with RT as planned and re-simulate based on clinical need during the 3rd or 4th week.

The only times I have had to do a re-simulation at the very beginning is in patients who have had complete dental extrac...

If the extractions are extensive, I typically wait.

But in a practical sense, it's often not until the patient has been seen by dentistry/oral surgery before I know what the extent will be, so I wait more often than not so as to ensure as reproducible a setup as possible.