Management of dental extractions in irradiated jaws: A protocol with hyperbaric oxygen therapy

Lambert, Paul M.; Intriere, Nancy; Eichstaedt, Ralph M.

doi:10.1016/s0278-2391(97)90541-3

Cited by 27 publications

(20 citation statements)

References 29 publications

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“…5 It is understandable that a correlation exists between the incidence of ORN and the total radiation received.The overall incidence of ORN decreased from around 12 per cent to 5.4 per cent after 1968 when megavoltage therapy became available. 6 Direct comparison of the figures appeared inappropriate in view of the existence of other variables (such as site of malignancy, patients' dental s t atus and awa r e n e s s , and the radiotherapeutic mode and technique).…”

Section: Discussionmentioning

confidence: 99%

Incidence of complicated healing and osteoradionecrosis following tooth extraction in patients receiving readiotherapy for treatment of nasopharyngeal carcinoma

Tong

Leung

Cheng

et al. 1999

Australian Dental Journal

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A group of 43 patients requiring tooth extraction after radiotherapy for nasopharyngeal carcinoma (NPC) was studied retrospectively to determine the incidence of post-extraction complications. It was found that because of the method used in the delivery of radiation, extraction of maxillary posterior teeth resulted in the greatest risk of complications (28.9 per cent), including a 10.5 per cent risk of osteoradionecrosis (ORN). Based on the findings, a protocol was established for the dental care of such patients. It was concluded that when extraction of maxillary posterior teeth was necessary, prophylactic antibiotics were not sufficient to prevent the complication of delayed healing. The risk of ORN was 10.5 per cent within the field of maximal radiation dose. Hyperbaric oxygen may be the better choice of preventive measures. However, in view of the low risk of ORN, wholesale prescription of hyperbaric oxygen therapy may not be indicated. An additional patient who had tooth extraction two weeks prior to radiotherapy was included to show that if adequate time for wound healing was not allowed, ORN could develop.

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Section: Discussionmentioning

confidence: 99%

Incidence of complicated healing and osteoradionecrosis following tooth extraction in patients receiving readiotherapy for treatment of nasopharyngeal carcinoma

Tong

Leung

Cheng

et al. 1999

Australian Dental Journal

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“…Extraction after 5 years radiotherapy (ORN) CARL and IKNER 12 5(0) 3(0) 0(0) MAKKONEN 54 4(0) 21(0) SCHWEIGER 73 16 (1) 8(1) BEUMER et al 9 14 (2) 48 (12) 10(2) WILDERMUTH and CANTRIL 87 1(0) 2(0) 2(0) 78 0 0 0% 7 0 0% DAVID et al 22 12 0 0% 12 0 0% TONG et al 81 0 0 0% 43 4 9.30% CARL and IKNER 12 2 0 0% 6 0 0% LAMBERT et al 46 15 most studies in the literature that the mandible has a higher risk of developing ORN compared with the maxilla 11,19,43,60,71,79 . The pattern of blood supply to the mandible has been implicated as a primary reason for this finding 37,79 .…”

Section: Authormentioning

confidence: 99%

“…Alveoloplasty and suturing of the socket are commonly performed to avoid ORN 9,12,16,28,46,50,58,74,81 . This procedure attempts to trim off sharp bony spicules and provide soft tissue cover for the sockets to prevent bone exposure 3,21,75 .…”

Section: Authormentioning

confidence: 99%

Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review

Nabil

Samman

2011

International Journal of Oral and Maxillofacial Surgery

285

266

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“…Many authors of articles on ORN either failed to mention antibiotics at all, or made only a brief comment about their general application. 1,5,8,11,12,[28][29][30] The purpose of this investigation was to determine prescribing for exodontia and minor oral surgery following radiotherapy by surveying current opinion amongst consultant oral and maxillofacial surgeons.…”

Section: N B R I E Fmentioning

confidence: 99%

“…6,7 The accepted cause is a progressive endarteritis with a decrease in the microcirculation. 8 The periosteum undergoes fibrosis, osteoblasts and osteocytes are destroyed and the marrow spaces in the bone become filled with fibrous tissue. The major risk factors for ORN are extractions or biopsies that overly bone.…”

mentioning

confidence: 99%

A survey of antibiotic prescribing by maxillofacial consultants for dental extractions following radiotherapy to the oral cavity

Kanatas¹,

Rogers

Martin

2002

Br Dent J

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Objectives To analyse the antibiotic prescribing trends for exodontia and minor oral surgery in patients with a history of radiotherapy. Also, to evaluate the use of hyperbaric oxygen as a separate modality in the prevention of osteoradionecrosis. Design A survey of antibiotic prescribing involving the analysis of a questionnaire which included the management of three patients with a history of head and neck malignancy. Method The heads of the departments in each unit in the UK were sent a closed-response questionnaire. Antibiotic prescribing was assessed in three case scenarios. Case one referred to a patient that had surgery alone as part of the management of head and neck cancer, who needed the surgical removal of second molar roots. Case two referred to a patient that had surgery and adjuvant radiotherapy as part of the management of head and neck cancer, and needed the same procedure as in case one. Case three included a patient with a history of surgery and adjuvant radiotherapy, who required the extraction of three mobile and periodontally-involved lower incisors. Consultants were also asked about the use of hyperbaric oxygen in the patients who had radiotherapy as part of their treatment strategy. Results A total of 109 questionnaires were sent to all the Maxillofacial Units in the UK. The response rate was 73%. In patients with a history of radical surgery alone for the management of head and neck cancer, 20% of the surgeons advocated pre-operative antibiotics for the surgical removal of lower posterior teeth. In contrast, in the patient with a history of adjuvant radiotherapy 86% supported pre-operative antimicrobial use for the surgical removal of the same teeth. In the extraction of mobile and periodontally involved lower incisors in the previously irradiated patient, 63% of the clinicians supported pre-extraction antibiotics. Postoperative antibiotics were advocated in 52% in the first case, 89% in the second case and 71% in the third case. 34% of the clinicians advocated hyperbaric oxygen for surgical removal of posterior teeth and 15% for the extraction of mobile anterior teeth.

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Management of dental extractions in irradiated jaws: A protocol with hyperbaric oxygen therapy

Cited by 27 publications

References 29 publications

Incidence of complicated healing and osteoradionecrosis following tooth extraction in patients receiving readiotherapy for treatment of nasopharyngeal carcinoma

Incidence of complicated healing and osteoradionecrosis following tooth extraction in patients receiving readiotherapy for treatment of nasopharyngeal carcinoma

Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review

A survey of antibiotic prescribing by maxillofacial consultants for dental extractions following radiotherapy to the oral cavity

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