Dental management before radiotherapy of the head and neck region: 4‐year single‐center experience

Abstract

Objective: To review our experience with a standardized dental management approach in patients with planned radiotherapy of the head and neck region based on preradiation and follow-up data.Material and Methods: Records of patients who underwent radiotherapy between June 2016 and November 2020 were reviewed. Data on dental findings and therapeutic recommendations were extracted from a prospectively managed database. Hospital records were used to obtain follow-up data.Results: Two hundred eighty-one patient records were identified. After the exclusion of 81 patients because of incomplete data, 200 patients were included in the study. Dental findings relevant to radiotherapy were found in 144 cases (72.0%). Teeth extractions were recommended in 112 (56.0%) patients. Follow-up data were available for 172 (86.0%) patients (mean follow-up: 16.8 ± 10.7 months).Radiodermatitis was the most frequently observed sequela of radiotherapy (42.4%), followed by dysphagia (38.4%) and stomatitis (36.6%). Osteoradionecrosis was observed in only 2.3% of the patients. Conclusion:Dental findings relevant to planned radiotherapy were frequent and in many cases resulted in recommendations for teeth extraction. Based on our standardized dental management protocol, we observed low rates of late oral complications after radiotherapy of the head and neck region.dental management, follow-up, oral cancer, radiotherapy | INTRODUCTIONRadiotherapy is a standard form of treatment for many head and neck tumors. Depending on the tumor entity, size, stage, localization, grade, resection status, and patient comorbidities, radiotherapy can be applied as an adjuvant or alternative to surgery. Where indicated, it can be combined with chemotherapy (Koga et al., 2008). Radiotherapy leads to a decreased proliferation rate or even apoptosis: the tumor stops growing or decays. Nevertheless, the cell-damaging effects of radiation therapy are nonspecific, and the tumorsurrounding tissue (i.e., oral mucosa, salivary glands, maxillary and mandibular bone, teeth, and masticatory muscles) is affected as well

Review of Osteoradionecrosis of the Jaw: Radiotherapy Modality, Technique, and Dose as Risk Factors

“…The rapid increase in osteoclast activity after RT and the gradual decrease in osteoblast activity in the weeks that followed are thought to be responsible for this phenomenon [45,47]. High-dose RT may alter the differentiation characteristics of skeletal stem cells in favor of decreased differentiation potential but increased radiation-induced cellular senescence, as evidenced by a robust galactosidase labeling signal that overlaps with cell death patterns [44,48].…”

“…According to the findings of basic research that provided the basis for Marx and colleagues' 3H (hypovascular, hypocellular, and hypoxic) theories and Delanian's radiationinduced fibroatrophic ORNJ theories [48,54], hypoxia, inflammation, and related cytokines appear to play a significant role in ORNJ genesis. Microvascular damage and subsequent vascular occlusion following RT are additional drivers of compromised bone integrity, which leads to hypovascularity, hypocellularity, local hypoxia, and fibroatrophic healing.…”

Pre- and Post-Operative Quality of Life in Patients with Osteoradionecrosis of the Jaw

“…Risk factors that can trigger the occurrence of ORNJ include age, gender, tumors of the oral cavity, tumors in close proximity to bony structures, type and duration of radiation, site of radiation, presence of infection, dental status, quality of dental treatments, smoking, and alcohol consumption [ 8 , 20 ]. Dental restorations prior to the initiation of radiation therapy and regular dental follow-ups during and after radiation treatment reduce the risk of ORNJ manifestation [ 7 , 21 , 22 ].…”