The impact of radiation caries on morbidity and mortality outcomes of head and neck squamous cell carcinoma patients

Abstract

AimsRadiation caries (RC) is a highly prevalent and chronic complication of head and neck radiotherapy (HNRT) and presents a challenge for clinicians and patients. The present study aimed to assess the impact of RC on the morbidity and mortality outcomes of head and neck squamous cell carcinoma (HNSCC) patients.Methods and ResultsPatients were divided into three groups: (1) RC (n = 20), (2) control (n = 20), and (3) edentulous (n = 20). Information regarding the number of appointments, dental procedures, osteoradionecrosis (ORN), prescriptions, and hospital admissions were collected. Mortality outcomes were assessed through disease‐free survival (DFS) and overall survival (OS) rates. RC patients required more dental appointments (p < .001), restorations (p < .001), extractions (p = .001), and antibiotic and analgesic prescriptions (p < .001). Kaplan–Meier subgroup analyses showed a significantly increased risk of ORN in RC compared to edentulous patients (p = .015). RC patients presented lower DFS rates (43.2 months) than the control and edentulous groups (55.4 and 56.1 months, respectively).ConclusionsRC impacts morbidity outcomes among cancer survivors due to increased demand for medication prescriptions, multiple specialized dental appointments, invasive surgical treatments, increased risk of ORN, and increased need for hospital admissions.

In regard to recent published study of Palmier et al. titled ‘The impact of radiation caries on morbidity and mortality outcomes of head and neck squamous cell carcinoma patients’. (Spec Care Dentist. 2023 Mar 5. https://doi.org/10.1111/scd.12843. Epub ahead of print.)

“…It is our pleasure to acknowledge Palmier and colleagues' contribution to our understanding of radiation caries (RC) and its impact on the morbidity and mortality outcomes of head and neck squamous cell carcinoma (HNSCC). 1 The authors divided 60 HNSCC patients into three groups based on the results of their dental and medical exams before and after radiotherapy (RT): RC (n = 20), control (n = 20), and edentulous (n = 20). The incidence of osteoradionecrosis (ORN) was remarkably higher in the RC group than in the edentulous group (55% vs. 20%; p = .015).…”

“…2 Unfortunately, Palmier et al relied solely on total RT doses delivered to tumor volumes instead of these more robust dosimetric parameters in drawing their conclusions. 1 Due to significant dependence on tumor size, disease stage, the proximity of the primary tumor or involved lymph node to the mandible, predetermined mandibular dose constraints, and the RT technique used, the total tumor dosage may not always reflect the doses received by the mandible. Therefore, without such reliable data, it may be incorrect to classify one group as having a higher ORN risk than another.…”

Impact of Irradiation on the Adhesive Performance of Resin-Based Dental Biomaterials: A Systematic Review of Laboratory Studies

“…Radiation-related caries occur in approximately 29% of patients within 3 months of completing treatment [ 9 , 10 ]. This susceptibility to caries is largely due to changes in saliva quantity and quality, as well as direct radiation effects on enamel and dentin [ 11 , 12 , 13 , 14 ]. In addition, oral trismus and mucositis, common side-effects of radiation therapy, can lead to inadequate biofilm control and increased consumption of carbohydrate-rich foods, both contributing factors to radiation-related caries [ 8 , 10 , 15 ].…”

“…Patients with head and neck cancer who undergo radiation therapy require comprehensive dental care, with special measures needed for caries prevention and control [ 11 , 15 , 16 , 17 ]. Owing to the high incidence of radiation-related caries, restorative interventions are often necessary [ 10 ].…”