The association between dental therapy timelines and osteoradionecrosis: a nationwide population-based cohort study

Huang, Yi; Liu, Shih‐Ping; Muo, Chih Hsin; Tsai, Chun‐Hao; Chang, Chung-Ta

doi:10.1007/s00784-019-02866-4

Cited by 23 publications

(5 citation statements)

References 30 publications

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“…However, the difference in timing of pre-RT extractions between the healed and ORN groups at the turning point of day 7 and day 14 is clinically meaningful. These findings are consistent with the study performed by Huang et al 24 that demonstrated an increased incidence of ORN in patients with pre-RT extractions performed within 2 weeks vs patients who did not undergo extractions. In a nationwide population-based retrospective study by Liao et al, 25 the incidence of ORN among 5062 patients with head and neck cancer with at least 1 tooth extraction pre-RT was 1.03%, results that are in keeping with our findings.…”

Section: Discussionsupporting

confidence: 93%

Dental Extractions Before Radiation Therapy and the Risk of Osteoradionecrosis in Patients With Head and Neck Cancer

Lee,

Hueniken,

Cuddy

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportancePatients with head and neck cancer undergo extraction of teeth with poor prognoses to minimize post-radiation therapy (RT) extractions, which are known to cause osteoradionecrosis (ORN). However, many patients are required to start RT before the extraction sites are completely healed. The role of pre-RT extractions in the development of ORN has been disputed in literature.ObjectiveTo determine whether the timing of pre-RT dental extractions is associated with ORN development in patients with head and neck cancer.Design, Setting, and ParticipantsThis retrospective cohort study was conducted at a single institution (Princess Margaret Cancer Centre, Toronto, Canada) between January 1, 2011, and January 1, 2018, and included 879 patients with head and neck cancer who underwent pre-RT dental extractions before curative RT of 45 Gy or greater. Patient demographic information and clinical characteristics (eg, primary cancer site, nodal involvement, chemotherapy, smoking status, dental pathology) were considered. Data analyses were performed from July to December 2022.Main outcomes and measuresTiming (number of days) from dental extractions to RT start date and pre-RT extractions categorized as healed, minor bone spicules (MBS), or ORN.ResultsThe study population consisted of 879 patients with a median (range) age of 62 (20-96) years, with 685 men (78%) and 194 women (22%). Of these, 847 (96.3%) healed from pre-RT dental extractions, 16 (1.8%) developed MBS, and 16 (1.8%) developed ORN. The median (range) time in number of days from pre-RT extraction(s) to start of RT was 9 (0-98) days in the healed cohort, 6 (3-23) days in the MBS cohort, and 6 (0-12) days in the ORN cohort. There was a large difference in the timing of pre-RT extractions between the healed and the MBS cohorts (mean 11.9 vs 7.4 days to radiation; difference 4.4; 95% CI, 1.5-7.3), and the healed and the ORN cohorts (mean 11.9 vs 7.1 days; difference 4.8 days; 95% CI, 2.6-7.1).ConclusionThe findings of this retrospective cohort study suggest that there was an important association between the timing of pre-RT dental extractions and ORN when extractions occurred within 7 days of the RT start date. Despite this, ORN after pre-RT extractions is relatively rare. These findings indicate that patients with head and neck cancer who are to undergo RT should not delay treatment for extractions when it might compromise oncologic control.

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Section: Discussionsupporting

confidence: 93%

Dental Extractions Before Radiation Therapy and the Risk of Osteoradionecrosis in Patients With Head and Neck Cancer

Lee,

Hueniken,

Cuddy

et al. 2023

JAMA Otolaryngol Head Neck Surg

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“…However, consensus on treatment was high prior to radiation therapy and often lead to extraction of the tooth. This is consistent with the difficulty of predicting the longevity of endodontically unsound teeth and the increased risk of ORN from endodontic treatment prior to radiation therapy [30].…”

Section: Consensus On Choice Of Dental Treatmentsupporting

confidence: 76%

Pre-medical dental evaluation and treatment of oral infection – a survey study among hospital-affiliated dentists in Sweden

Olsson

Mattsson

Bültzingslöwen

et al. 2021

Acta Odontologica Scandinavica

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Objective: To examine how hospital-affiliated dentists assess risk and evaluate oral foci of infection in patients facing certain medical treatments, and whether the nature of upcoming medical treatment affects the choice of dental intervention. Materials and methods: A survey comprising six clinical cases (50 teeth) was sent to hospital-affiliated dentists in Sweden. A treatment option for the affected tooth/teeth in each case was selected whether the patient was facing heart valve surgery, chemotherapy, radiation therapy, intravenous bisphosphonate treatment, solid organ transplantation or was diagnosed with endocarditis. Results: Consensus in choice of dental treatment was high in 62%, moderate in 32% and low in 6% of the assessments. High variability of choice of treatment was seen for eight teeth whereas the remaining 42 teeth often received the same therapy regardless of medical issue. Chemotherapy and radiotherapy were thought to entail the highest risk for oral infectious sequelae with a risk ranging from 1% to 100%. Conclusion: Pre-medical dental evaluations and recommended treatments are often uniform with the exception of the management of asymptomatic root canal treated teeth with persisting apical radiolucency and heavily decayed molars. In many instances, dental diagnosis has a greater impact on choice of treatment than the underlying medical issue and associated implications thereof.

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“…Teeth and periodontal tissue can be a route of bacterial invasion. RT causes poor circulation in periodontal tissue, and periodontal health influences the occurrence of ORN 22 , 23 . A recent study showed that extraction of teeth with a poor prognosis before RT significantly reduced the risk of occurrence of ORN 24 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for pathological fracture in patients with mandibular osteoradionecrosis

Ohori

Iwata

Takeda

et al. 2023

Sci Rep

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Osteoradionecrosis (ORN) often results in pathological fractures through progression. We aimed to identify the risk factors for pathological fracture in patients with mandibular ORN. Seventy-four patients with mandibular ORN were included in this retrospective study. We investigated various risk factors for pathological fracture in patients with mandibular ORN, including number of mandibular teeth with a poor prognosis each at initial evaluation before radiation therapy (RT) and when fracture occurred, and the proportion of antibiotic administration period in a follow-up duration after RT. The rate of occurrence of pathological fractures in patients with mandibular ORN was 25.7%. The median of duration between RT completion and fracture occurrence was 74.0 months. We found that pathological fracture was significantly associated with a larger number of mandibular teeth with a poor prognosis at initial evaluation before RT (P = 0.024) and when fracture occurred (P = 0.009). Especially, a larger number of mandibular teeth with P4 periodontitis, in other words severe periodontal status, was related to pathological fracture in both timings. The proportion of antibiotic administration period in a follow-up duration was also significant risk factor (P = 0.002). Multivariate analyses showed statistically significant associations between pathological fracture and a larger number of mandibular teeth with a poor prognosis when fracture occurred (hazard ratio 3.669). The patient with a larger number of mandibular teeth with P4 periodontitis may have a risk of not only occurrence of ORN but resulting in pathological fracture by accumulation of infection. Surgeons should consider extraction of those teeth regardless of before/after RT if necessary for infection control.

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The association between dental therapy timelines and osteoradionecrosis: a nationwide population-based cohort study

Cited by 23 publications

References 30 publications

Dental Extractions Before Radiation Therapy and the Risk of Osteoradionecrosis in Patients With Head and Neck Cancer

Dental Extractions Before Radiation Therapy and the Risk of Osteoradionecrosis in Patients With Head and Neck Cancer

Pre-medical dental evaluation and treatment of oral infection – a survey study among hospital-affiliated dentists in Sweden

Risk factors for pathological fracture in patients with mandibular osteoradionecrosis

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