Objectives: Studies have shown radiotherapy (RT) used for treatment of nasopharyngeal carcinoma (NPC) results in varying degrees of side-effects such as mucositis, hyposalivation, radiation caries, trismus and osteoradionecrosis (ORN) in patients. The objective of this survey is to report the reasons for tooth extractions pre-RT; occurrence of caries, periodontitis and ORN post-RT. Methods: Data was retrieved from the dental records of 54 patients who were seen from 2 Nov 1998 to 2 Nov 1999 for pre-RT dental clearance. Results: All were Chinese (35M, 19F) with ages at time of NPC diagnosis ranging from 26-81 years (highest frequency: 40-49 year age range). A total of 148 teeth were extracted pre-RT: periodontitis (64), impaction/poor access to good oral hygiene (35), non-functional teeth (27), poor restorability due to advanced caries (22). In this sample of patients, there was a tendency for anterior teeth caries development: 9.3% (5/54) of patients 0-1 year post-RT; 26.1% (12/46) 1-2 years post-RT; 48.6% (18/37) 3-5 years; 54.5% (6/11) 5-10 years post-RT. A similar pattern was observed for posterior teeth suggesting tooth position may not be a factor in caries occurrence post-RT. 31 tooth extractions were done post-RT due to caries (23) ; periodontitis (5) and other reasons (3). Occurrence of ORN was 1 out of 4 extractions in 3 patients at 0-1yr post-RT and 1 out of 12 extractions in 3 patients at 3-5yrs post-RT. Conclusions: Within the limitations of this study, caries and periodontitis tended to occur post-RT despite regular reviews and symptomatic treatment in this sample of patients. More may need to be done for these patients such as periodic periodontal charting to detect disease, caries susceptibility tests in addition to stringent follow-up reviews.