Dental extractions for preradiation dental clearance and incidence of osteoradionecrosis in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy.

Abstract

The aims of the present retrospective study were to evaluate the outcomes of dental extractions in nasopharyngeal carcinoma patients who had undergone dental clearance pre- and post-radiotherapy (RT) with intensity-modulated RT, and to report on the incidence and timing of osteoradionecrosis (ORN) in these patients. A total of 231 patients were seen pre-, mid-, and postradiation therapy. Information on patient demographics, smoking history, staging, treatment modalities, dental extraction indications, and number and site of dental extractions was gathered. Wilcoxon two-sample tests and Fisher's exact test were used to test the association between groups for patient variables. The mean number of teeth removed was 4.1 teeth per patient. A total of 334 (35.2%) teeth were removed for periodontal reasons, 322 (34.03%) were removed prophylactically, and the remaining teeth were removed because of deep caries, retained roots, partial impaction, endodontic lesions, and prosthodontic reasons. Patients had an average of 19.6 teeth remaining after dental clearance, and only 97 (42%) required prosthetic intervention. The statistical analysis showed that there was no correlation between dental extractions pre- or post-RT and the development of ORN. No specific parameter was directly associated with dental extractions, although smoking and increased number of teeth removed preradiation seemed to be prevalent in patients who developed ORN.