Tooth extraction before radiotherapy is a risk factor for developing osteoradionecrosis of the jaws: A systematic review

Abstract

The head and neck region is an anatomical heterogeneous area that comprises numerous specialised tissues of all lineages, which can give rise to different malignancies, among which squamous cell carcinomas are the most frequent. For this malignancy, a new staging system based on TNM classification was recently published (Lydiatt et al., 2017). These cancers represent the seventh most common malignancy worldwide, accounting for 750,000 new cases per year and causing approximately 340,000 deaths annually (Bray et al., 2018). Radiotherapy (RT) has gained a fundamental role in the treatment of head and neck cancers, and nearly 75% of all these patients undergo this therapy, either with curative, adjuvant or palliative indication (Ratko, Douglas, de Souza, Belinson, & Aronson, 2014).

Osteoradionecrosis of the Jaws Due to Teeth Extractions during and after Radiotherapy: A Systematic Review

“…(2011) [ 9 ]. Comparing the final data obtained from this systematic review (5.8% of ORN in post-RT) with those of extractions performed before radiotherapy (2.2%), reported in a systematic review already conducted by our research group [ 30 ], it seems reasonable to consider post-RT extractions as a high-risk procedure and suggest performing them before starting RT. These results are in contrast with the findings emerging from another systematic review, which did not retrieve statistically significant differences in the ORN risk between patients undergoing tooth extractions before RT and patients undergoing tooth extractions after RT [ 31 ].…”

“…It was impossible to draw definitive conclusions about other clinical risk factors, including the time-lapse to respect between RT and tooth extractions. Data gathered from the analyzed literature presented a higher rate of ORN (5.8%) when compared with extractions performed before RT (2.2%) [ 30 ]; even if the general trend of ORN is decreasing for both pre- and post-RT extractions, studies performed on extraction after RT presented a peculiar bimodal trend: studies before 1990 show a much higher ORN rate compared with those performed after 1990, which are proximate to 0%. Reasons for this bimodal behaviour are not completely understood; possible explanations are that the introduction of the more advanced radiotherapy techniques and the greatest role of the dental clinician for H&N cancer supportive therapy could have improved oral conditions of patients after RT.…”

Oral lesions induced by radiation exposure: An update and literature review

“…In addition, this study highlights the variables that influence the ORN prevalence: oral mucositis condition (PR = 3.03; 95% CI: 1.30-7.03), history of smoking (PR = 0.23; 95% CI: 0.07-0.74), number of teeth removed before radiotherapy (PR = 1.06; 95% CI: 1.01-1.11) and visit to the dentist before radiation (PR = 0.08; 95% CI: 1.02-1.11) [30] . A review of Madrid et al of 2010 points out that probably the greatest risk factor for the development of ORN is dental extraction after radiation therapy, feature also confirmed by another very recent study [31] . Prevention must therefore provide for the extraction of teeth compromised by caries or periodontitis before the start of radiotherapy [32] .…”

Dental Evaluation Prior to Cancer Therapy

“…Conventionally, the objective of dental clearance has been to eliminate all dental pathology prior to anti-neoplastic therapy. However, the complete clearance approach may carry some risk of complications arising from the dental treatment itself [ 2 , 73 – 75 ]. Tai et al reported that 40% of patients who had third molar extractions prior to their anti-neoplastic therapy developed post-operative complications (e.g., alveolar osteitis) [ 76 ].…”