Incidence of complicated healing and osteoradionecrosis following tooth extraction in patients receiving readiotherapy for treatment of nasopharyngeal carcinoma

Abstract

A group of 43 patients requiring tooth extraction after radiotherapy for nasopharyngeal carcinoma (NPC) was studied retrospectively to determine the incidence of post-extraction complications. It was found that because of the method used in the delivery of radiation, extraction of maxillary posterior teeth resulted in the greatest risk of complications (28.9 per cent), including a 10.5 per cent risk of osteoradionecrosis (ORN). Based on the findings, a protocol was established for the dental care of such patients. It was concluded that when extraction of maxillary posterior teeth was necessary, prophylactic antibiotics were not sufficient to prevent the complication of delayed healing. The risk of ORN was 10.5 per cent within the field of maximal radiation dose. Hyperbaric oxygen may be the better choice of preventive measures. However, in view of the low risk of ORN, wholesale prescription of hyperbaric oxygen therapy may not be indicated. An additional patient who had tooth extraction two weeks prior to radiotherapy was included to show that if adequate time for wound healing was not allowed, ORN could develop.

A survey of antibiotic prescribing by maxillofacial consultants for dental extractions following radiotherapy to the oral cavity

“…The literature generally supports the use of peri-extraction antibiotics 19,25,26,27,31,32 for patients at risk of ORN, however there is an evident lack of detail concerning the type, dose and timing of antibiotic prophylaxis. Evidence is lacking upon which to base unequivocal guidelines as reflected by the diversity of practice reported in this survey.…”

“…When available and in cases where radiation dose to the mandible has been greater than 50 gray, prophylactic HBO should be considered. 30,36 Although the use of amoxicillin, metronidazole and clindamycin are choices which conform with recent recommendations 31 the duration of the course given varied from 3 to 28 days and on one occasion until healing had been completed (Table 1). Such action exposes the absence of a definitive oral health protocol for patients at risk of ORN.…”

Oral Sequelae of Head and Neck Radiotherapy

“…The incidence of osteoradionecrosis of the mandible varies from 2.6% to 22%; the range is most commonly from 5% to 15% in recent reports (Constantino et al, 1995;Epstein et al, 1997;Thorn et al, 2000). The incidence of osteoradionecrosis of the maxilla is much lower (Curi and Dib, 1997;Tong et al, 1999;Thorn et al, 2000).…”

Osteoradionecrosis of the Mandible and Mastoiditis after Radiotherapy for Parotid Mucoepidermoid Carcinoma

“…9 The management of patients afflicted with ORN of the jaw usually consists of a combination of different modalities and is determined by factors such as the size of the defect, the signs and symptoms of the patient, and the cosmetic and functional derangement consequent to the complication. 8 For a nonresponsive case, or the diffuse type of osteoradionecrosis, surgical management is indicated. Surgical management of osteoradionecrosis has met with limited success because of the difficulty of accurately assessing the viability of nonnecrotic bone.…”

“…It is generally accepted that meticulous preventive dental treatment should be planned for patients receiving radiotherapy to the head and neck region. 8 In addition to oral hygiene maintenance with routine dental follow-up, non-surgical or 'conservative' therapy includes nutritional support, topical medicaments, systemic antibiotics, and hyperbaric oxygen. 8 In 1983, Marx 9 proposed a staging protocol (subsequently modified) that combined surgery and hyperbaric oxygen for more aggressive treatment of ORN.…”