Background and purpose <p>Radiation therapy (RT) is a cornerstone of head and neck squamous cell carcinoma (HNSCC) treatment, often used alongside surgical approaches, delivering curative doses between 50–70 Gy. Pre-RT dental screenings aim to prevent oral complications by extracting teeth with poor prognosis, particularly in high-dose areas exceeding 40 Gy. The aim of the present study was to measure the planned radiation doses received on dentition during definitive or postoperative radiation therapy for HNSCC.</p> Material and methods <p>This retrospective study analyzed 91 HNSCC cases treated with RT at Oulu University Hospital (2018–2021), assessing radiation doses to dentition, mandible, and parotid glands across different tumor sites.</p> Results <p>Results showed that ipsilateral RT spared contralateral and frontal dental regions more effectively than bilateral RT, particularly in oral cavity and oropharyngeal cancers. Conversely, hypopharyngeal and laryngeal cancers rarely exposed dentition to doses above 40 Gy. Bilateral RT often exceeded the 40 Gy threshold in mandibular and parotid regions, particularly in oral cavity cancers, underscoring the need for precise dose planning to balance tumor control with oral health preservation.</p> Conclusion <p>The findings highlight that ipsilateral RT can reduce the need for pre-RT dental extractions in contralateral regions and provide a basis for optimizing dental care strategies. By understanding dose distributions, balance can be addressed between minimizing oral health impacts and ensuring effective HNSCC treatment.</p>