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Dental Prophylaxis and Osteoradionecrosis: A Population-Based Study.

C T Chang1,2, S P Liu3,4,5, C H Muo6

  • 11 Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan.

Journal of Dental Research
|January 19, 2017
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Summary

Dental scaling and chlorhexidine mouth rinse before radiotherapy increase osteoradionecrosis (ORN) risk in head and neck cancer patients. Fluoride gel showed no significant association with ORN occurrence.

Keywords:
clinical practice guidelinesfluoride(s)oncologyosteonecrosisradiologysupportive oral care

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Area of Science:

  • Oncology
  • Dental Medicine
  • Radiotherapy

Background:

  • Osteoradionecrosis (ORN) is a severe complication following radiotherapy for head and neck cancer (HNC).
  • Dental prophylactic measures before radiotherapy are crucial but their specific impact on ORN risk requires further investigation.

Purpose of the Study:

  • To investigate the association between various dental prophylactic modalities and the risk of osteoradionecrosis (ORN) in HNC patients.
  • To determine the influence of timing for scaling, chlorhexidine mouth rinse use, and fluoride gel application on ORN incidence.

Main Methods:

  • A large cohort study of 18,231 HNC patients from Taiwan's Longitudinal Health Insurance Database for Catastrophic Illness Patients.
  • Stratification based on dental prophylaxis (chlorhexidine, scaling, fluoride) and Cox proportional hazard regression analysis to compare ORN incidences.

Main Results:

  • Scaling and chlorhexidine mouth rinse were significantly associated with increased ORN risk (P = 0.004 and P < 0.0001, respectively).
  • Chlorhexidine use increased ORN risk 2.43-fold in oral cancer patients. Scaling within 2 weeks before radiotherapy increased ORN incidence by 1.28-fold.
  • Fluoride gel application showed no significant association with increased ORN occurrence.

Conclusions:

  • Dental prophylaxis before radiotherapy is strongly correlated with ORN in HNC patients.
  • Specific interventions like chlorhexidine exposure and early scaling (within 2 weeks pre-radiotherapy) significantly elevate ORN risk, particularly in oral cancer patients.
  • An optimal dental prophylaxis protocol should consider cancer location, judicious chlorhexidine use, and appropriate scaling timing to mitigate ORN risk.