How critical is the interval between extractions and irradiation in patients with head and neck malignancy?

doi:10.1016/0030-4220(77)90317-6

Oral Surgery, Oral Medicine, Oral Pathology

Volume 43, Issue 3, March 1977, Pages 333-337

Oral Surgery, Oral M...

https://doi.org/10.1016/0030-4220(77)90317-6 Get rights and content

Abstract

The postirradiation response of patients who had teeth removed and who received irradiation directly to the surgical sites is evaluated. Intraoral sequelae are studied in relation to the time period between extractions and the initiation of radiotherapy.

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Cited by (43)

Timing of dental extractions in patients undergoing radiotherapy and the incidence of osteoradionecrosis: a systematic review and meta-analysis
2021, British Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
This study, however, was excluded from the meta-analysis, as it did not describe the total number of participants. When considering the optimal healing time for extraction sites before RT to minimise the risk of ORN, several authors agreed that a minimum of 10-14 days was necessary.37,49 Epstein et al also cautioned that the healing time can vary for each patient, depending on comorbidities, radiation fields, and site of extraction.36
This systematic review aimed to examine whether the incidence of osteonecrosis differed between patients who have dental extractions before or after radiotherapy (RT). The reported incidence of osteoradionecrosis (ORN) of the jaws following RT to the head and neck varies widely in the literature. Currently, for patients with head and neck cancer there are no universally accepted guidelines on the optimal timing of dental surgery relative to RT to minimise incident ORN. A literature review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) criteria. A search of PubMed, EMBASE, Evidence-Based Medicine, and Web of Science databases targeted literature published up to and including 10 April 2020. Two independent reviewers assessed studies for eligibility against inclusion criteria. An assessment of bias was conducted for each of the included studies and relevant data extracted. A meta-analysis was undertaken using the statistical methods described. Twenty-four of 708 studies were included. They were heterogeneous and included a wide variation of RT methods, head and neck malignancies, and comorbidities. While some concluded that the incidence of ORN was dependent on the timing of dental extractions in relation to RT, with regard to the risk of its development, others reported additional factors such as age, comorbidities, extent of surgical resection, and dose and field of radiation, as more important predictors than timing. In many there was consistent lack of detail around the timing of dental procedures in relation to the delivery of RT. From 21 studies including 36,294 patients, of whom 14,389 had extractions before RT, the pooled incidence of ORN was 5.5% (95% CI: 2.1% to 10.1%). Significant heterogeneity was found in Cochran’s Q-test (p < 0.001) and Higgins I² = 98.0%. From 21 studies including 37,805 patients, of whom 6030 had extractions after RT, the pooled incidence of ORN was 5.3% (95% CI: 2.9% to 8.2%). Significant heterogeneity was found in Cochran’s Q-test (p < 0.001) and Higgins I² = 80.0%. There was no statistically significant difference between these two groups (random-effects model Q=0.12, p=0.73). Large, longitudinal studies with a priori-specified methods are needed to identify, recruit, and prospectively follow patients with head and neck cancer for the onset of ORN after dental surgery. This will allow clinical guidelines to be established to assist clinicians to plan treatment when extractions are indicated in patients undergoing RT to the head and neck.
Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Dental pathologies and osteoradionecrosis (Part 1) literature review and consensus statement
2016, Critical Reviews in Oncology/Hematology
Radiotherapy alone or in combination with chemotherapy and/or surgery is the typical treatment for head and neck cancer patients. Acute side effects (such as oral mucositis, dermatitis, salivary changes, taste alterations, etc.), and late toxicities in particular (such as osteo-radionecrosis, hypo-salivation and xerostomia, trismus, radiation caries etc.), are often debilitating. These effects tend to be underestimated and insufficiently addressed in the medical community.
A multidisciplinary group of head and neck cancer specialists met in Milan with the aim of reaching a consensus on clinical definitions and management of these toxicities.
The Delphi Appropriateness method was used for developing the consensus, and external experts evaluated the conclusions. This paper contains 10 clusters of statements about the clinical definitions and management of head and neck cancer treatment sequels (dental pathologies and osteo-radionecroses) that reached consensus, and offers a review of the literature about these topics.
The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecroses (10 clusters of statements), whereas this second part deals with trismus and xerostomia.
Incidence of osteoradionecrosis in patients who have undergone dental extraction prior to radiotherapy: A systematic review and meta-analysis
2014, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Citation Excerpt :
Most authorities agree that a time period of 10–14 days should elapse between extractions and irradiation, some recommend a 21-day delay [5,36]. However, one study showed that a shorter time interval (10 days) does not seem to be associated with a higher risk of ORN [37]. Oral health status is another risk factor for ORN, and oral health care is an important element in the prevention of this condition.
This meta-analysis aimed to identify the incidence of osteoradionecrosis in patients who have undergone dental extraction prior to radiotherapy.
A meta-analysis of observational studies of the incidence of osteoradionecrosis in patients who have undergone pre-radiotherapy dental extraction was conducted. Two reviewers searched the PubMed, Cochrane Library, ScienceDirect, and Embase databases to identify relevant studies. Pooled incidence estimates were calculated using a random-effects model. Meta-regression was conducted to identify factors associated with the incidence of osteoradionecrosis.
Eleven studies were included in the analyses. The incidence of osteoradionecrosis in the patients who underwent pre-radiotherapy dental extraction was 4.16% (95% confidence interval, 1.17–7.16%). Radiotherapy technology, radiation dose, and prophylactic antibiotic use did not significantly affect this incidence.
The incidence of osteoradionecrosis was very low. Future research should investigate the effects of mandibular radiation dose, dose fractionation, time interval of extraction, oral health status and drug risk factors on the incidence of osteoradionecrosis.
Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: A systematic review
2011, International Journal of Oral and Maxillofacial Surgery
This systematic review aims to identify and review the best available evidence to answer the clinical question ‘What are the incidence and the factors influencing the development of osteoradionecrosis after tooth extraction in irradiated patients?’. A systematic review of published articles on post-irradiation extraction was performed via electronic search of the Medline, Ovid, Embase and Cochrane Library databases. Additional studies were identified by manual reference list search. Evaluation and critical appraisal were done in 3 stages by two independent reviewers and any disagreement was resolved by discussion with a third party. 19 articles were selected for the final analysis. The total incidence of osteoradionecrosis after tooth extraction in irradiated patients was 7%. When extractions were performed in conjunction with prophylactic hyperbaric oxygen, the incidence was 4% while extraction in conjunction with antibiotics gave an incidence of 6%. This systematic review found that while the incidence of osteoradionecrosis after post-irradiation tooth extractions is low, the extraction of mandibular teeth within the radiation field in patients who received a radiation dose higher than 60 Gy represents the highest risk of developing osteoradionecrosis. Based on weak evidence, prophylactic hyperbaric oxygen is effective in reducing the risk of developing osteoradionecrosis after post-radiation extractions.
Dental extractions related to head and neck radiotherapy: ten-year experience of a single institution
2008, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology
Citation Excerpt :
Previous oral evaluation also permits execution of exodontias with a sufficient time for alveolar healing. This examination must not delay the commencement of irradiation.6,8,11,12,16,21,24 The median time found in the present study was 24 days.
This study evaluates the frequency of osteoradionecrosis associated with dental extractions.
A total of 405 patients submitted to radiotherapy and had dental extractions were evaluated. The patients were divided into 3 groups.
In group 1, 316 patients were submitted to 1.647 dental extractions (mean 5.2 teeth per patient) and in another 47 patients the number of teeth removed was not clearly reported. Group 2 comprised 5 patients who had 33 teeth extracted (mean 6.6 each). In group 3, 55 patients had 290 teeth removed (mean 5.3 each) and in another 2 patients the number of dental extractions could not be established. In general, only 3 cases of osteoradionecrosis related to dental extractions were observed: 2 related to exodontias performed before and 1 after radiotherapy.
The low prevalence of osteoradionecrosis found in this work suggests the possibility of performing exodontias after radiotherapy by experienced dentists in the management of head and neck cancer.
Dental Treatment Planning and Management in the Patient Who Has Cancer
2008, Dental Clinics of North America
Citation Excerpt :
Allowing for 3 weeks of healing time after extractions is ideal in patients who require radiotherapy. Because of numerous factors that may delay therapy in patients with head and neck cancer, a shorter time than 3 weeks between dental procedures and radiotherapy is more commonly available [33]. Thus, similar to the patients undergoing chemotherapy, the dentist and oncologist must consider the risk of infection versus poor healing during and after radiotherapy if less than 3 weeks is available.
The oral cavity has the potential to be a major source of short-term and long-term complications from cancer therapy. Appropriate evaluation and elimination of potential sources of oral infection before cancer therapy is vital because oral bacteria are a known source of bacteremia and septicemia during cancer therapy. Cancer diagnosis with previous and planned treatment, past medical history, past dental history, current medications, drug allergies, social history, family history, laboratory values, extraoral findings, intraoral findings, and radiographic findings must all be evaluated in planning dental treatment for these complex cases.

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How critical is the interval between extractions and irradiation in patients with head and neck malignancy?

Abstract

Radiation Necrosis of the Mandible

Radiology

Management of Dental Problems in Irradiated Patients, Refresher Course

Prevention and Management of Dental Problems in Irradiated Patients

J. Am. Soc. Prev. Dent

Osteoradionecrosis of the Jaws

Cancer Bull

Oral Surgery and the Patient Who Has Had Radiation Therapy for Head and Neck Cancer

Oral Surg

Dental Care of the Radiated Patient

J. Hosp. Dent. Pract

Management of Teeth in the Irradiated Patient

J. Am. Dent. Assoc

Therapeutic Radiology

Oral Surgery