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An audit of dental assessments including orthopantomography and timing of dental extractions before radiotherapy for head and neck cancer

British Dental Journal volume 232, pages 38–43 (2022)Cite this article

Abstract

Introduction Head and neck cancer (HNC) patients should receive a dental assessment at an appropriate time before commencing radiotherapy (RT), to prevent complications such as osteoradionecrosis (ORN) if extractions are required. A recent orthopantomogram radiograph (OPG) is part of this assessment.

Aim To compare the delivery of pre-RT dental assessment at the Regional Oncology Centre against national guidelines in regard to OPG assessments and timing of extractions.

Materials and methods A consecutive cohort of patients treated curatively were selected within two timeframes (January to March 2018 and January to March 2019) using multidisciplinary team records at Liverpool University Hospital. Patient notes, x-ray images and records were examined.

Results In total, 145 patients were identified. Eighty-nine percent (129) had an OPG radiograph and 72% (104) had a pre-RT dental assessment. Oral and laryngeal sites had the highest number of missed assessments. Altogether, 54 patients had dental treatment, with 47 undergoing extractions. Extractions were completed a median 13 days before RT started. By November 2020, no patients had been diagnosed with ORN.

Conclusions Three-quarters of patients received a pre-RT assessment but there is scope for improvement. OPGs should be part of initial HNC staging and referral to Regional Oncology Centre dental services should be made as part of the pre-RT workup.

Key points

  • All patients should receive a pre-radiotherapy dental assessment, regardless of being dentate or edentulous and irrespective of the site of the primary tumour.

  • Effective, timely integration of dental assessment into the patient pathway before commencing radiotherapy is one of the ways to reduce the risk of post-extraction osteoradionecrosis.

  • Including an orthopantomogram radiograph with head and neck cancer staging scans, together with referral to the dental services within regional oncology centres as part of the pre-radiotherapy workup, should improve rates of pre-radiotherapy dental assessments.

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Authors and Affiliations

  1. Locum Trust Grade/Core Trainee in Oral and Maxillofacial Surgery, Liverpool Head and Neck Centre, Liverpool University Hospitals Aintree, Liverpool, UK

    Rhydian King

  2. Senior Dental Officer, Wirral Community Dental Services, Wirral, UK

    Chien Li

  3. Medical Statistician, Director of Astraglobe Ltd, Congleton, Cheshire, UK

    Derek Lowe

  4. Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK; Liverpool Head and Neck Centre, Liverpool University Hospitals Aintree, Liverpool, UK

    Simon N. Rogers

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  1. Rhydian King
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  2. Chien Li
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Contributions

Rhydian King: methodology, investigation, writing - original draft, writing - review and editing. Chien Li: investigation, writing - review and editing. Derek Lowe: statistical analysis, writing - review and editing. Simon Rogers: conceptualisation, writing - review and editing, supervision.

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Correspondence to Rhydian King.

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King, R., Li, C., Lowe, D. et al. An audit of dental assessments including orthopantomography and timing of dental extractions before radiotherapy for head and neck cancer. Br Dent J 232, 38–43 (2022). https://doi.org/10.1038/s41415-021-3823-0

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