Post-radiotherapy head and neck cancer patients are at increased risk of dental caries due to radiotherapy-induced salivary gland hypofunction and radiation damage to tooth structure. Dental caries causes pain and discomfort and is likely to have a detrimental impact on patients' quality of life. This systematic review appraised and synthesised best available evidence regarding the incidence and severity of post-radiotherapy dental caries in head and neck cancer patients. Six databases and two trial registries were searched from their inception to May 2019. A total of 22 papers met the inclusion criteria. The pooled percentage of patients that developed dental caries postradiotherapy was 29% (n=15 studies; 95% CI 21%, 39%; I 2 =88.0%). Excluding studies with longer than two years follow-up, the pooled percentage was 37% (n=9 studies; 95% CI 25%, 51%; I 2 =88.6%). Meta-regression analysis revealed that studies with a higher mean/median radiotherapy dose exposure had an increased incidence of dental caries (p=0.02). Furthermore, studies with a higher proportion of patients treated with chemotherapy had an increased incidence of dental caries (p=0.02) after the exclusion of an outlier. It is important to be mindful of the high degree of observed heterogeneity and the inclusion of a large number of non-randomised studies. Data regarding the number of carious teeth, the number of carious tooth surfaces, and the number of carious lesions that developed post-radiotherapy were unsuitable for meta-analysis. There is a need for well-designed studies to improve understanding about dental cariesrisk in post-radiotherapy head and neck cancer patients. Highlights This review summarised the incidence of post-radiotherapy dental caries. Pooled estimates for post-radiotherapy caries ranged from 29-37%. A narrative review of the severity of post-radiotherapy caries is also presented. Comprehensive oral care is needed for head and neck cancer patients. Keywords Head and neck neoplasms Radiotherapy Dental caries Chemotherapy Oral health Abbreviations: CI-confidence intervals CM-Ciaran Moore (reviewer) CML-Conor McLister (reviewer) DMFS-decayed, missing, or filled tooth surfaces DMFT-decayed, missing, or filled teeth DNA-deoxyribonucleic acid GMK-Gerry McKenna (reviewer) HANC-head and neck cancer IMRT-intensity modulated radiation therapy *Manuscript (without author details) Click here to view linked References ORN-osteoradionecrosis PRISMA-Preferred Reporting Items for Systematic Reviews and Meta-Analyses PROSPERO-International Prospective Register of Systematic Reviews SD-standard deviation Author Type of study Year of Publication Number of patients Follow-up (months) Caries (outcome) data Caries assessment Site of head and neck cancer Age (years) Gendermale (%)

BackgroundCardiac rehabilitation (CR) programmes offering secondary prevention for cardiovascular disease (CVD) advise healthy lifestyle behaviours, with the behaviour change techniques (BCTs) of goals and planning, feedback and monitoring, and social support recommended. More information is needed about BCT use in home-based CR to support these programmes in practice.AimTo identify and describe the use of BCTs in home-based CR programmes.Design and settingRandomised controlled trials of home-based CR between 2005 and 2015 were identified by searching MEDLINE®, Embase, PsycINFO, Web of Science, and Cochrane Database.MethodReviewers independently screened titles and abstracts for eligibility. Relevant data, including BCTs, were extracted from included studies. A meta-analysis studied risk factor change in home-based and comparator programmes.ResultsFrom 2448 studies identified, 11 of good methodological quality (10 on post-myocardial infarction, one on heart failure, 1907 patients) were included. These reported the use of 20 different BCTs. Social support (unspecified) was used in all studies and goal setting (behaviour) in 10. Of the 11 studies, 10 reported effectiveness in reducing CVD risk factors, but one study showed no improvement compared to usual care. This study differed from effective programmes in that it didn’t include BCTs that had instructions on how to perform the behaviour and monitoring, or a credible source.ConclusionSocial support and goal setting were frequently used BCTs in home-based CR programmes, with the BCTs related to monitoring, instruction on how to perform the behaviour, and credible source being included in effective programmes. Further robust trials are needed to determine the relative value of different BCTs within CR programmes.

Background Many factors determine dietary intake in older adults, including physical health, psychological well-being and socio-economic status. Dental status may also be important. The aim was to examine how dental status impacts perceived ability to eat to certain foods, nutrient intake and nutritional status in UK older adults. Methods Data collected by the National Diet and Nutrition Survey Rolling Programme was analysed. A 4-day food diary assessed dietary intake, while a Computer Assisted Personal Interview collected socio-demographic, health behaviour and oral health information. Participants aged 65 years and over ( n = 1053) were categorised into three groups according to their dental status: edentate with dentures (E-DEN, n = 292), dentate with dentures (D-DEN, n = 305) or dentate with no dentures (DEN, n = 456). A total of 515 participants provided a blood sample that was used to assess nutrient concentrations including vitamin B12, vitamin C, ferritin, vitamin B6 (pyridoxal-5-phosphate, PLP), retinol, β-carotene and 25-hydroxyvitamin D (25-OH-D). Multiple regression methods were performed to examine cross-sectional associations between dental status, food selection, nutrient intake and nutritional status. Results Both E-DEN and D-DEN groups, compared with the DEN group, were more likely to report difficulty eating apples, raw carrots, lettuce, nuts, well-cooked steak and crusty bread ( P < 0.01). No group differences were observed in perceived ability to eat sliced bread, sliced cooked meats and cheese. The E-DEN group compared with the DEN group had lower mean daily intakes of omega 3 fatty acids ( P = 0.006), non-starch polysaccharides ( P = 0.001), β-carotene ( P = 0.001), folate ( P = 0.001), vitamin C ( P = 0.008), magnesium ( P < 0.001) and potassium (P < 0.001), and had lower plasma vitamin B6 PLP ( P = 0.001), vitamin C ( P = 0.009) and β-carotene ( P = 0.015) concentrations, after adjusting for socio-demographic and health behavioural factors. Compared with the DEN group, the D-DEN group did not have lower nutrient intakes or lower blood nutrient concentrations. Conclusions Within this sample of older adults, impaired dental status appears to influence food selection, and intake of important nutrients. Future research should focus on developing dental interventions coupled with dietary counselling to encourage the adoption of healthy eating habits in this high-risk population group.