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An audit into the timing of dental extractions pre-head and neck radiotherapy and the prevalence of osteoradionecrosis

British Dental Journal (2022)Cite this article

Abstract

Objective It is recommended that radiotherapy for head and neck cancer commences ten days post-dental extractions to reduce the risk of osteoradionecrosis (ORN) of the jaw. However, consideration must be given to patients' survival which might be compromised by delaying radiotherapy for these patients. The records of 154 patients receiving radiotherapy to the head and neck were retrospectively reviewed between July 2016 and August 2017, at Queen Alexandra Hospital in Portsmouth, to identify patients who have developed ORN, associated risk factors and the relative timings of dental extractions compared to the guidelines of the Royal College of Surgeons (RCS).

Results Of a sample of 154 head and neck cancer patients receiving radiotherapy, 125 were assessed before radiotherapy, with 102 of these patients (81.2%) requiring dental extractions. This audit indicated that a prevalence of 1.3% of patients developed ORN after radiotherapy, with the timing of dental extractions appearing to show no correlation. Overall, 98.7% of patients were treated as per the current guidelines, with 1.3% of patients breaching the current ten-day protocol.

Conclusion In total, 1.3% of 154 head and neck cancer patients treated with radiotherapy between July 2016 and August 2017 developed ORN after a follow-up period of a minimum of 20 months, with the majority of patients within the RCS guidelines for dental extractions, although further improvements and audit cycles are required.

Key points

  • Head and neck cancers are commonly treated with radiotherapy in combination with other treatment modalities.

  • Higher-dose radiotherapy increases the risk of osteoradionecrosis following dental extractions.

  • All patients should be dentally assessed before receiving radiotherapy to reduce the risk of osteoradionecrosis.

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Authors and Affiliations

  1. Oral Surgery, Edinburgh Dental Institute, Edinburgh, Mid-Lothian, EH3 9HA, UK

    Rhys Ward

  2. Department of Restorative Dentistry, Head & Neck Services, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK

    Ria Kanani & Shihab A.  Romeed

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  1. Rhys Ward
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  2. Ria Kanani
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  3. Shihab A.  Romeed
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All authors are the main authors of this paper and have contributed equally to all parts of this manuscript.

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Correspondence to Shihab A.  Romeed.

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Ward, R., Kanani, R. & Romeed, S. An audit into the timing of dental extractions pre-head and neck radiotherapy and the prevalence of osteoradionecrosis. Br Dent J (2022). https://doi.org/10.1038/s41415-022-3992-5

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