Dental Medicine Emerges as Critical Partner in Head and Neck Cancer Care at CU Anschutz
Key Insights
A structured pre-radiation dental clearance program at CU Anschutz, led by Dr. Petros Yoon and Dr. Ryan Lanning, integrates dentistry directly into oncology care to reduce serious complications like osteoradionecrosis (search).
The collaborative model features clear referral guidelines, a dedicated clinic session, and standardized clearance forms that support both academic and community dentists in managing cancer patients.
Dental clearance principles extend beyond head and neck cancer (search) to bone marrow transplant, solid organ transplant, and certain cardiac procedures, highlighting the broader role of oral health in medically complex patients.
When a patient is diagnosed with head and neck cancer (search), the path to treatment demands meticulous coordination across multiple disciplines. At the University of Colorado Anschutz (search) Medical Campus, dental medicine has moved from the periphery to become an essential clinical partner in ensuring safe and effective cancer care — and the institution is now sharing its model as a blueprint for other centers and community practices.
At the CU Anschutz School of Dental Medicine, this integration is being advanced through a structured, collaborative approach to pre-radiation dental clearance, led by Petros Yoon, DDS '15, assistant professor in the Department of Diagnostic Sciences and Surgical Dentistry and Director of Intake and Care Referral. Working in close partnership with Ryan Lanning, MD, PhD, associate professor in the Department of Radiation Oncology at the CU School of Medicine and UCHealth, Dr. Yoon helps coordinate a system that aligns dental evaluation with the urgency and complexity of oncology treatment.
"We recommend dental clearance for every head and neck cancer (search) patient," Dr. Yoon said, reflecting a standard of care that prioritizes both immediate safety and long-term outcomes.
The Risk of Osteoradionecrosis and the Case for Dental Clearance
For patients undergoing radiation therapy to the head and neck, dental clearance serves as a vital component of treatment planning. Its primary purpose is to reduce the risk of complications that arise when compromised oral health intersects with radiation-induced tissue changes.
Foremost among these concerns is osteoradionecrosis (search) (ORN), a condition in which irradiated bone loses its ability to heal. After radiation, even routine dental extractions can lead to non-healing wounds, exposed bone, and chronic infection. To mitigate this risk, the dental team works to eliminate active and likely sources of infection before radiation begins. This includes addressing advanced dental caries or lesions likely to progress, periodontal disease, and non-restorable teeth within the radiation field.
The goal is to preserve dentition whenever possible while proactively managing conditions that could lead to complications later. Decisions often involve balancing ideal dental care against the realities of a narrow treatment window. Dental clearance is typically completed several weeks before radiation planning, and this compressed timeline can limit more complex interventions, requiring the dental and oncology teams to carefully weigh risks.
Building a Coordinated Model of Care
Together, Dr. Yoon and Dr. Lanning designed a structured referral and clearance system that now serves patients from the CU Anschutz Cancer Center and other UCHealth sites. The model rests on three pillars: clear guidelines specifying which conditions should prompt extraction or root canal before radiation and which should not delay life-saving cancer therapy; a dedicated clinic session in the CU Anschutz Dental Faculty Practice reserved for patients referred from UCHealth; and a standardized dental clearance form that guides community dentists through what constitutes urgent dental need versus care that can safely wait.
The workflow is deliberately built to support community dentists. "We prioritize working with a patient's established dentist whenever possible, allowing them to complete the clearance and maintain continuity of care," Dr. Yoon noted. For patients who come through the cancer center without a dental home, many choose to remain within the Anschutz ecosystem after their clearance, establishing ongoing care in the Dental Faculty Practice.
Extending the Principles Beyond Oncology
While the current workflow focuses on pre-radiation dental clearance for head and neck cancer (search), the same principles apply to other medically complex scenarios. Bone marrow transplant patients often require comprehensive dental evaluation before they become immunosuppressed. Solid organ transplant candidates need chronic oral infections managed so they do not progress under immunosuppressive therapy. Certain cardiac procedures and valve replacements also involve dental clearance to reduce infectious risk.
Dr. Yoon's background positions him uniquely for this work. After completing a general practice residency at UNC Chapel Hill, where he routinely managed hospital-based clearances for cardiac, transplant, and radiation patients, he practiced in a rural Salud clinic in Sterling, Colorado, continuing to collaborate with a local radiation oncologist. He later completed oral medicine training at Harvard School of Dental Medicine, working on an oral oncology service that managed the oral side effects of chemotherapy, immunotherapy, and radiation.
Yet he is clear that this is not a niche reserved only for specialists. "You don't have to be an oral medicine specialist to complete radiation dental clearances," he emphasized. "Our general dentists in the community can help. That's why we created a standardized process documentation to share."
Long-Term Oral Health After Radiation
The role of dental medicine extends well beyond the completion of dental clearance. Radiation-induced changes — including xerostomia (search) (dry mouth), increased caries risk, and reduced jaw mobility — require ongoing management to protect oral health and quality of life. Dr. Yoon emphasizes preventive strategies that include consistent oral hygiene practices, daily use of prescription fluoride products often with custom trays or high-fluoride toothpaste, and regular dental follow-up and monitoring.
"These are lifelong considerations," he said, emphasizing the importance of preserving teeth and avoiding invasive procedures after radiation whenever possible.
The collaborative model at CU Anschutz demonstrates how structured workflows, strong partnerships, and patient-centered education can transform what was once an ad-hoc process into a reliable standard of care. By embedding dentistry within the cancer team, the campus is not only protecting patients today but also creating a replicable framework that can be shared with other centers and community practices nationwide.