Comment on: Prevalence of acute periapical abscesses in head and neck cancer patients receiving radiotherapy

Abstract

Dear Editor,We appreciate and commend the study conducted by Katz et al., which aimed to assess the frequency of acute periapical abscess (PA) in individuals who underwent radiation therapy (RT) for head and neck cancer (HNC). 1 This research addresses an important but often overlooked topic of head and neck oncology. The query of relevant databases was used to obtain data on acute PAs diagnosed by skilled dentists and oropharyngeal cancer (OPC) diagnoses, with or without a history of RT. The prevalence of acute PAs and its connection with a history of OPC with or without RT were assessed by calculating the odds ratio (OR) after adjusting for comorbidities, including gingival, periodontal diseases, diabetes, and smoking history. The occurrence of acute PAs among patients with a history of OPC was notably higher than the hospital's overall patient population (OR: 2.92, p < .0001). Upon adjusting for diabetes, smoking, gingival, and periodontal diseases, the ORs were found to be reduced; nevertheless, the differences remained significant (p < .05 for each). The incidence of PA was even more prevalent among OPC patients who received RT (OR: 3.61, p < .0001). According to these findings, the authors inferred that OPC patients had a significantly elevated likelihood of developing acute PA, and this risk further increased if they had received RT. While acknowledging the significance and value of the research's findings in highlighting the need for planned dental examinations and the impact of RT on the oral health of OPC patients, we have three noteworthy suggestions about this captivating study.First, it is clear from the study that the RT doses, especially the mean and Vx doses (percentage of structural volume receiving X Gy or more), exposed to the tooth and jaw regions of interest were not included in the treatment features of the individuals. Nevertheless, dosimetric data are paramount to HNC patients since most acute or late RT-induced complications, excluding stochastic effects, depend on the total and per percent doses received by the region of concern. 2,3 For example, Hommez et al. evaluated 628 teeth in a study of HNC patients treated with RT and