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

Abstract

AimsHead and neck cancer is a serious condition affecting the life of patients. Radiotherapy is commonly used to treat such conditions. The aim of this study was to assess the prevalence of acute periapical abscesses (PAs) in patients who received radiotherapy for head and neck cancer.Methods and resultsData on acute PAs and oropharyngeal cancer (OPC) diagnosis with or without a history of radiation therapy (RAD) was retrieved by searching the appropriate query in the database. All cases were diagnosed for acute PAs by calibrated dentists for patients admitted to urgent care. The odds ratio (OR) for the prevalence of acute PAs and its association with a history of OPC with or without RAD were then calculated. Adjustment for comorbidities such as diabetes, smoking and gingival and periodontal diseases was also done. The prevalence of acute PAs in patients with a history of OPC was significantly higher as compared to the general hospital patient population (OR 2.92, 95%CI, p < .0001). Males were more affected than females and whites were more affected than African Americans and other ethnicities. The prevalence for PAs in patients with a history of OPC and RAD was higher and the difference in prevalence was statistically significant (OR 3.61, 95%CI, p < .0001). Whites were more affected than African Americans by more than 3.5‐fold. Adjustment for diabetes comorbidly affected mainly the OPC + RAD group, however, the difference remained statistically significant. Adjustment for smoking and gingival and periodontal disease reduced the OR but the difference remained statistically different.ConclusionsThe high prevalence of acute PAs in patients with a history of OPC and RAD may suggest an association between these conditions warranting a meticulous medical and dental examination.

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

“…9 Therefore, it is highly likely that ORN may develop in some vulnerable patients with PA, considering infections as a triggering factor, even though the incidence of ORN in Katz et al's extensive patient cohort remains unreported. 1 But, providing the ORN rates in irradiated patients with and without PA could shed light on the relationship between infections and the development of ORN, a topic debated among head and neck oncology experts. 10 If an association between PA patients and ORN after head and neck RT can be shown, such evidence may enable us to stratify them as high-risk and implement timely protective measures through strict followups.…”

“…wileyonlinelibrary.com/journal/scd 1293 PA, caused by diverse bacterial strains before undergoing RT. 11,12 However, the study by Katz et al does not provide information on whether certain patients had pre-existing PA before RT, which could help determine the actual rates of radiation-induced PA. 1 In a study by Steiner et al, 124 root canal-treated teeth from 51 patients were analyzed retrospectively before and after intensity-modulated RT (IMRT). 13 The results revealed that radiolucency was evident in the periapical area of 34.7% of patients before IMRT, which increased to 46% after IMRT.…”