Dental status, dental rehabilitation procedures, demographic and oncological data as potential risk factors for infected osteoradionecrosis of the lower jaw after radiotherapy for oral neoplasms: a retrospective evaluation

Abstract

PurposeRetrospective evaluation of the dental status of patients with oral cancer before radiotherapy, the extent of dental rehabilitation procedures, demographic and radiotherapy data as potential risk factors for development of infected osteoradionecrosis of the lower jaw.MethodsA total of 90 patients who had undergone radiotherapy for oral cancer were included into this retrospective evaluation. None of them had distant metastases. After tumour surgery the patients were referred to an oral and maxillofacial surgeon for dental examination and the necessary dental rehabilitation procedures inclusive potential tooth extraction combined with primary soft tissue closure. Adjuvant radiotherapy was started after complete healing of the gingiva (> 7 days after potential extraction). The majority of patients (n = 74) was treated with conventionally fractionated radiotherapy with total doses ranging from 50-70Gy whereas further 16 patients received hyperfractionated radiotherapy up to 72Gy. The records of the clinical data were reviewed. Furthermore, questionnaires were mailed to the patients’ general practitioners and dentists in order to get more data concerning tumour status and osteoradionecrosis during follow-up.ResultsThe patients’ dental status before radiotherapy was generally poor. On average 10 teeth were present, six of them were regarded to remain conservable. Extensive dental rehabilitation procedures included a mean of 3.7 tooth extractions. Chronic periodontitis with severe attachment loss was found in 40%, dental biofilm in 56%. An infected osteoradionecrosis (IORN) grade II according to (Schwartz et al., Am J Clin Oncol 25:168-171, 2002) was diagnosed in 11 of the 90 patients (12%), mostly within the first 4 years after radiotherapy. We could not find significant prognostic factors for the occurrence of IORN, but a trendwise correlation with impaired dental status, rehabilitation procedures, fraction size and tumour outcome.ConclusionThe occurrence of IORN is an important long-term side effect of radiotherapy for oral cancers. From this data we only can conclude that a poor dental status, conventional fractionation and local tumour progression may enhance the risk of IORN which is in concordance with the literature.

The impact of oral rehabilitation on oral health-related quality of life in patients receiving radiotherapy for the treatment of head and neck cancer

“…Functional limitations and disfiguring facial deformities often occur and result in psychological stress and social marginalization. According to accepted theories, a substantial cause for ORN (in addition to the irradiation dose) is teeth destroyed by radiation caries [5]. Affected or decayed teeth may be an entry port for pathogenic germs into the bone that induce its necrosis.…”

Osteoradionecrosis of the mandible: A ten year single-center retrospective study

“…Numerous factors have been associated with the risk of ORN development (Morrish et al, 1981, Kluth et al, 1988, Jereczek-Fossa and Orecchia, 2002, Reuther et al, 2003, Niewald et al, 2013. They can be divided into three main groups (Jereczek-Fossa and Orecchia, 2002):…”

ATR-FTIR Assessment of the Biochemical Composition and Micro Hardness of the Hard Tissues of Oral Cavity Submitted to Gamma Irradiation

“…The determination of effects caused by ionizing radiation, using dose for patients with head and neck cancer, in terms of variations in biochemical composition and surface microhardness [22][23][24][25][26][27][28][29][30][31], as a first step as pathophysiology comprehension, will be helpful for reduced or to eliminate inherent radiotherapy complications. Moreover, it could focus on more details from specific issues as dose reduced fractionation protocols and modalities, as long as data obtained from in vitro studies [31][32][33][34][35][36][37][38][39][40].…”