Abstract
ObjectiveTo seek evidence for osteoradionecrosis (ORN) after dental extractions before or after intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC).MethodsMedline/PubMed, Embase, and Cochrane Library were searched from 2000 until 2020. Articles on HNC patients treated with IMRT and dental extractions were analyzed by two independent reviewers. The risk ratios (RR) and odds ratios (OR) for ORN related to extractions were calculated using Fisher’s exact test. A one-sample proportion test was used to assess the proportion of pre- versus post-IMRT extractions. Forest plots were used for the pooled RR and OR using a random-effects model.ResultsSeven of 630 publications with 875 patients were eligible. A total of 437 (49.9%) patients were treated with extractions before and 92 (10.5%) after IMRT. 28 (3.2%) suffered from ORN after IMRT. ORN was associated with extractions in 15 (53.6%) patients, eight related to extractions prior to and seven cases related to extractions after IMRT. The risk and odds for ORN favored pre-IMRT extractions (RR = 0.18, 95% CI: 0.04–0.74, p = 0.031, I2 = 0%, OR = 0.16, 95% CI: 0.03–0.99, p = 0.049, I2 = 0%). However, the prediction interval of the expected range of 95% of true effects included 1 for RR and OR.ConclusionTooth extraction before IMRT is more common than after IMRT, but dental extractions before compared to extractions after IMRT have not been proven to reduce the incidence of ORN. Extractions of teeth before IMRT have to be balanced with any potential delay in initiating cancer therapy.
Highlights
Introduction and objectivesIonizing radiation (IR) inhibits wound healing and damaged irradiated tissue has reduced healing abilities [1]
In this systematic review and meta-analysis using published patient data, we reviewed the existing literature in order to answer the question of whether dental extractions prior to intensity-modulated radiotherapy effectively decrease the risk of developing ORN
In September 2019, a first search was conducted for the Medline/PubMed, the Embase, and the Cochrane Library online databases for articles published between 2000 and 2020 which report on head and neck cancer patients with dental extractions undergoing intensity-modulated radiotherapy (IMRT) and developing ORN afterwards
Summary
Ionizing radiation (IR) inhibits wound healing and damaged irradiated tissue has reduced healing abilities [1]. IR of the oral and pharyngeal mucosa and the salivary glands leads to changes of the oral milieu, including decreasing pH and saliva quantity, and changes in bacterial composition [2, 3]. Oral hygiene is helpful for preserving teeth and reduces adverse side effects of radiotherapy (RT) [4]. A severe side effect is osteoradionecrosis (ORN), characterized by the exposure and devitalization of the bone, causing severe pain, swelling, or difficulties with eating. Poor dental status predisposes for dental decay and ORN if left untreated during, prior to, or after RT [5–7].
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