Oral Health Status in Patients with Head and Neck Cancer before Radiotherapy: Baseline Description of an Observational Prospective Study

Rupe, Cosimo; Basco, Alessia; Schiavelli, Anna; Cassano, Alessandra; Miccichè, Francesco; Galli, Jacopo; Cordaro, Massimo; Lajolo, Carlo

doi:10.3390/cancers14061411

Cited by 13 publications

(10 citation statements)

References 48 publications

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“…With regard to oral health in different subsets of HNSCC patients, the results of the present study are in line with two previous studies, where the DMFT varied between 15 and 21 [1] or 16.2 and 18.3 [2], the number of edentulous patients varied between 0 and 37% [1], and the number of present teeth varied between 17.2 and 21.1 [2]. Due to different assessment criteria, the periodontal status cannot be directly compared across these studies.…”

Section: Discussionsupporting

confidence: 93%

“…Patients with head and neck squamous cell carcinoma (HNSCC) often present a poor oral health already at the time of diagnosis [1,2], which is then further reduced during radio (chemo)therapy [3,4]. Besides classical risk factors, such as tobacco exposure, alcohol abuse, or human papillomavirus (HPV) infection, several previous studies found poor oral hygiene or poor oral health status to be independent risk factors for HNSCC [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Oral health in patients with different sites of head and neck squamous cell carcinoma is not different

Kanzow,

Mielke,

Haupt

et al. 2023

PLoS ONE

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Oral health might not only act as risk factor for head and neck squamous cell carcinoma (HNSCC), but might also have a predictive value for the patients’ survival. Currently, information on the effect of oral health on survival of patients with different sites of HNSCC is lacking. This single-center retrospective study aimed to compare oral health in patients with different sites of HNSCC and to analyse whether oral health is associated with survival in the different subsets of HNSCC patients. Dental records of HNSCC patients referred for dental assessment prior to radio(chemo)therapy were included. Patient-related parameters (age at time of diagnosis, sex, tobacco exposure, alcohol consumption, HPV status), treatment data (primary treatment, intent), performance status, tumor demographics (anatomical site, TNM staging), and oral health parameters (DMFT, periodontal health, teeth with/without root canal treatment and with/without periodontitis apicalis) were obtained. Oral health parameters were compared between different anatomical sites. Survival of all HNSCC patients and of individual subsets was assessed using Kaplan-Meier statistics, and the effect of tumor demographics, patient-related parameters, and oral health on survival was analysed by cox regression analyses (α = 5%). 371 patients with HNSCC (oral: n = 86, oropharyngeal: n = 174, hypopharyngeal: n = 59, laryngeal: n = 15, other: n = 37) were included. Oral health parameters did not differ between subsets (padj.≥0.199). Five-year cumulative survival of HNSCC patients amounted to 78.6%. Only for HNSCC originating in the oral cavity and oropharynx, survival was associated with the treatment intent (p = 0.015) or performance status (p = 0.007) in the multivariable analyses, respectively. Within the limitations of this study, oral health was not different between different subsets and had no significant effect on survival of HNSCC patients.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Oral health in patients with different sites of head and neck squamous cell carcinoma is not different

Kanzow,

Mielke,

Haupt

et al. 2023

PLoS ONE

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“…To date, limited information on the oral health of the specific group of OPSCC patients is available. In a recent study from Italy, the median DMFT of OPSCC patients amounted to 16, 82% of the patients were affected from periodontitis and only 2% were edentulous ( 1 ). Two studies from the UK reported a mean number of 19 to 22 present teeth, a DMFT of 15 to 17, and a moderate alveolar bone loss ( 4 , 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…Oral health is often compromised in patients with head and neck squamous cell carcinoma (HNSCC) (1)(2)(3)(4). Several previous studies found a positive association between poor oral health or poor oral hygiene and HNSCC (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Oral health in HPV-positive and HPV-negative patients with oropharyngeal squamous cell carcinoma

et al. 2023

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This study compared oral health in oropharyngeal squamous cell carcinoma (OPSCC) patients with positive or negative human papillomavirus (HPV) status and analysed whether oral health was associated with survival. Patients referred for dental assessment prior to radio(chemo)therapy between 2009 and 2019 were included. Patient-related risk factors for OPSCC (alcohol, tobacco, HPV status), age, sex, treatment (primary treatment, intent), performance status, tumor/node/metastasis (TNM) staging, and oral health parameters (DMFT, periodontal status, teeth with/without root canal treatment and with/without periodontitis apicalis) were compared between HPV-negative and HPV-positive patients. Survival was assessed using Kaplan-Meier statistics. The effect of patient-related risk factors and oral health parameters was analysed by cox regression analyses (α=5%). A total of 119 patients (n=50 HPV-negative, n=69 HPV-positive) was included. HPV-positive patients showed more present teeth, a higher number of filled teeth, were less often edentulous and presented a lower DMFT compared to HPV-negative patients (padj.≤0.003). Among dentulous patients, HPV-positive patients showed more present teeth and fewer teeth with periodontitis apicalis lacking a root canal treatment (padj.≤0.036). Survival probability differed between groups (p=0.006) and trended towards being associated with HPV status, tobacco exposure, performance status, T stage, N stage, and the number of missing or filled teeth as well as the number of root canal treated teeth with periodontitis apicalis and the number of teeth with periodontitis apicalis lacking a root canal treatment (p≤0.077). However, only tobacco exposure, performance status, and the number of teeth with periodontitis apicalis lacking a root canal treatment in dentulous patients remained significant in the multivariate analyses (p≤0.047). HPV-negative patients with OPSCC showed a poorer oral health compared to HPV-positive patients, but survival was not associated with oral health.

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“…Special attention is needed when further RT treatment is needed, considering the higher risk of oral sequelae. All patients are visited with the support of orthopantomography (OPT), and periapical radiographs, whenever possible, are performed to detect dental diseases 14,15 . First, anagraphic and anamnestic data were carefully recorded, particularly focusing on the oncologic history of the patient and on exposure to risk factors for oncologic and dental diseases.…”

Section: Methodsmentioning

confidence: 99%

Clinical outcomes of teeth adjacent to the site of mandibulotomy or mandibulectomy in patients with head and neck cancer: results from a multidisciplinary mono-institutional head and neck tumor board

Castagnola

Rupe

Gioco

et al. 2023

Preprint

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Introduction: The aim of this case series was to evaluate the necrosis of teeth adjacent to the site of mandibulotomy or mandibulectomy in a cohort of patients suffering from head and neck cancers. Methods: Fourteen patients who underwent segmental mandibulectomy or paramedian mandibulotomy for oral, oropharynx or major salivary gland cancer and a total of 23 teeth were included in this case series. Twelve patients underwent adjuvant head and neck radiotherapy. Cold sensitivity pulp testing and/or electric pulp testing were performed on teeth at the margin of mandibulectomy and on teeth adjacent to mandibulotomy after surgery. A “positive” response was considered the healthy state, and “negative” was considered the diseased state of the tooth. Results: The 10 patients who underwent mandibulotomy had 12 teeth with a negative response. The 4 patients treated by mandibulectomy had two positive and three negative responses to cold and electric pulp tests. Fifteen out of 23 teeth (65.2%) showed a negative response to sensitivity testing. Conclusions: Tooth necrosis seems to be a common event after mandibulectomy and mandibulotomy. Clinical Relevance: To avoid post-surgery complications, performing root canal therapy before surgery on the teeth adjacent to the surgical site could be an appropriate strategy.

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Oral Health Status in Patients with Head and Neck Cancer before Radiotherapy: Baseline Description of an Observational Prospective Study

Cited by 13 publications

References 48 publications

Oral health in patients with different sites of head and neck squamous cell carcinoma is not different

Oral health in patients with different sites of head and neck squamous cell carcinoma is not different

Oral health in HPV-positive and HPV-negative patients with oropharyngeal squamous cell carcinoma

Clinical outcomes of teeth adjacent to the site of mandibulotomy or mandibulectomy in patients with head and neck cancer: results from a multidisciplinary mono-institutional head and neck tumor board

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