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Preradiation full mouth extractions in head and neck cancer: case-control study
Adriana Iturbide1, Brianna Hughes1, Vishawdeep Dhaliwal1
1Department of Oral Medicine/Oral & Maxillofacial Surgery, Wake Forest University School of Medicine, Atrium Health Carolinas Medical Center, Charlotte, NC, USA.
Objectives:
Assess factors associated with recommended full-mouth extraction (FME) before radiation therapy (RT) for head-and-neck cancer (HNC).
Methods:
We compared 60 patients with a FME recommendation (cases) to 60 patients with a recommendation to save teeth before RT (controls). Controls were enrolled in the "Clinical Registry of Dental Outcomes in H&N Cancer Patients" (OraRad).
Results:
FME cases had an average of 15.2 teeth extracted pre-RT vs 3.8 for controls. FME Cases were average age 61 years; 68% were male and 95% diagnosed with squamous cell carcinoma (SCC). Controls were average age 57 years; 75% were male and 87% diagnosed with SCC. Factors associated with FME cases included lack of dental insurance, history of noncompliance with dental care and less frequent oral care. Cases also had more teeth with periapical lesions (1.3 vs 0.42, P = .0007), radiographic caries evidence (4.2 vs 2.5, P = .006), pulpal exposure (1.8 vs 0.5, P = .0005), and radiographic bone loss (46% vs 22%, P < .0001). The 2-year rate of osteoradionecrosis was 5% for cases and 6.3% for controls.
Conclusions:
This study's cases and controls differed on many tooth- and patient-related factors. Decision-making leading to a pre-RT FME recommendation appears related to level of dental disease, oral hygiene history, accessibility to care and motivation to maintain teeth. FME cases and controls had similar 2-year osteoradionecrosis rates despite substantially different numbers of pre-RT extractions.
