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The association between dental therapy timelines and osteoradionecrosis: a nationwide population-based cohort study

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Abstract

Objectives

The study aimed to investigate the timeline association with specific dental therapy and osteoradionecrosis (ORN) in oral cancer patients.

Materials and methods

A total of 7394 oral cancer patients, including 198 ORN subjects, were retrieved from a Longitudinal Health Insurance Database for Catastrophic Illness Patients of Taiwan and were analyzed with the Cox proportional hazard regression to compare the ORN risk of individual dental treatments under different dental treatments.

Results

The initial dental treatment time significantly impacted on the risk of ORN in oral cancer patients (P<0.05). Pre-radiotherapy endodontic treatment and post-radiotherapy scaling or subgingival curettage increased ORN prevalence (hazard ratio [HR], 2.28 and 1.77, respectively). Endodontic treatment within 2 weeks to 1 month prior to radiotherapy increased the ORN risk by 5.83-fold. Dental scaling or subgingival curettage initialized from three to 6 months post-radiotherapy raised the ORN prevalence by 2.2-fold. Exodontia initialized within 2 weeks before radiotherapy (HR=1.49) or 1 to 3 months after radiotherapy (HR=2.63) greatly increased ORN prevalence. To perform oral surgery from 3 months pre-radiotherapy to 6 months after radiotherapy increased the 1.85-fold ORN risk. The chemotherapy combined oral surgery increased the ORN prevalence by 2.55-fold.

Conclusions

Timing of dental treatment, including pre-radiotherapy endodontic treatment, post-radiotherapy scaling or subgingival curettage, and oral surgery or exodontia before and after radiotherapy, could closely relate to ORN development in oral cancer patients.

Clinical relevance

Choosing right time to perform appropriate dental treatment could effectively reduce oral infection and ORN risk.

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References

  1. Chrcanovic BR, Reher P, Sousa AA, Harris M (2010) Osteoradionecrosis of the jaws--a current overview--part 1: physiopathology and risk and predisposing factors. Oral Maxillofac Surg 14:3–16. https://doi.org/10.1007/s10006-009-0198-9

    Article  PubMed  Google Scholar 

  2. Mendenhall WM (2004) Mandibular osteoradionecrosis. J Clin Oncol 22:4867–4868. https://doi.org/10.1200/jco.2004.09.959

    Article  PubMed  Google Scholar 

  3. Schwartz HC, Kagan AR (2002) Osteoradionecrosis of the mandible: scientific basis for clinical staging. Am J Clin Oncol 25:168–171

    Article  PubMed  Google Scholar 

  4. Wahl MJ (2006) Osteoradionecrosis prevention myths. Int J Radiat Oncol Biol Phys 64:661–669. https://doi.org/10.1016/j.ijrobp.2005.10.021

    Article  PubMed  Google Scholar 

  5. Owosho AA, Kadempour A, Yom SK, Randazzo J, Jillian Tsai C, Lee NY, Shaha AR, Huryn JM, Estilo CL (2015) Radiographic osteoradionecrosis of the jaw with intact mucosa: proposal of clinical guidelines for early identification of this condition. Oral Oncol 51:e93–e96. https://doi.org/10.1016/j.oraloncology.2015.09.009

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mirabile A, Numico G, Russi EG, Bossi P, Crippa F, Bacigalupo A, De Sanctis V, Musso S, Merlotti A, Ghi MG, Merlano MC, Licitra L, Moretto F, Denaro N, Caspiani O, Buglione M, Pergolizzi S, Cascio A, Bernier J, Raber-Durlacher J, Vermorken JB, Murphy B, Ranieri MV, Dellinger RP (2015) Sepsis in head and neck cancer patients treated with chemotherapy and radiation: literature review and consensus. Crit Rev Oncol Hematol 95:191–213. https://doi.org/10.1016/j.critrevonc.2015.03.003

    Article  PubMed  Google Scholar 

  7. Costantino PD, Friedman CD, Steinberg MJ (1995) Irradiated bone and its management. Otolaryngol Clin N Am 28:1021–1038

    Google Scholar 

  8. Conference NC (1989) Oral complications of cancer therapies: diagnosis, prevention, and treatment. National Institutes of Health consensus development conference consensus statement 7:1–11

    Google Scholar 

  9. Thorn JJ, Hansen HS, Specht L, Bastholt L (2000) Osteoradionecrosis of the jaws: clinical characteristics and relation to the field of irradiation. J Oral Maxillofac Surg 58:1088–1093; discussion 1093-5. https://doi.org/10.1053/joms.2000.9562

    Article  PubMed  Google Scholar 

  10. Sulaiman F, Huryn JM, Zlotolow IM (2003) Dental extractions in the irradiated head and neck patient: a retrospective analysis of Memorial Sloan-Kettering Cancer Center protocols, criteria, and end results. J Oral Maxillofac Surg 61:1123–1131

    Article  PubMed  Google Scholar 

  11. Hutchinson I (1996) Complications of radiotherapy in the head and neck: an orofacial surgeon’s view. Current radiation oncology Arnold, London:144–177

  12. Chang CT, Liu SP, Muo CH, Tsai CH, Huang YF (2017) Dental prophylaxis and osteoradionecrosis: a population-based study. J Dent Res 96:531–538. https://doi.org/10.1177/0022034516687282

    Article  PubMed  Google Scholar 

  13. Buglione M, Cavagnini R, Di Rosario F, Sottocornola L, Maddalo M, Vassalli L, Grisanti S, Salgarello S, Orlandi E, Paganelli C, Majorana A, Gastaldi G, Bossi P, Berruti A, Pavanato G, Nicolai P, Maroldi R, Barasch A, Russi EG, Raber-Durlacher J, Murphy B, Magrini SM (2016) 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. Crit Rev Oncol Hematol 97:131–142. https://doi.org/10.1016/j.critrevonc.2015.08.010

    Article  PubMed  Google Scholar 

  14. Villa A, Akintoye SO (2018) Dental management of patients who have undergone oral cancer therapy. Dent Clin N Am 62:131–142. https://doi.org/10.1016/j.cden.2017.08.010

    Article  PubMed  Google Scholar 

  15. Kuhnt T, Stang A, Wienke A, Vordermark D, Schweyen R, Hey J (2016) Potential risk factors for jaw osteoradionecrosis after radiotherapy for head and neck cancer. Radiation oncology (London, England) 11:101. https://doi.org/10.1186/s13014-016-0679-6

    Article  Google Scholar 

  16. See Toh YL, Soong YL, Chim YX, Tan LT, Lye WK, Teoh KH (2018) Dental extractions for preradiation dental clearance and incidence of osteoradionecrosis in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy. J Investig Clin Dent 9:e12295. https://doi.org/10.1111/jicd.12295

    Article  PubMed  Google Scholar 

  17. Lambade PN, Lambade D, Goel M (2013) Osteoradionecrosis of the mandible: a review. Oral Maxillofac Surg 17:243–249. https://doi.org/10.1007/s10006-012-0363-4

    Article  PubMed  Google Scholar 

  18. Kojima Y, Yanamoto S, Umeda M, Kawashita Y, Saito I, Hasegawa T, Komori T, Ueda N, Kirita T, Yamada SI, Kurita H, Senga Y, Shibuya Y, Iwai H (2017) Relationship between dental status and development of osteoradionecrosis of the jaw: a multicenter retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 124:139–145. https://doi.org/10.1016/j.oooo.2017.04.012

    Article  PubMed  Google Scholar 

  19. Silverman S Jr, Chierici G (1965) Radiation therapy of oral carcinoma. I. Effects on oral tissues and management of the periodontium. J Periodontol 36:478–484

    Article  PubMed  Google Scholar 

  20. Owosho AA, Tsai CJ, Lee RS, Freymiller H, Kadempour A, Varthis S, Sax AZ, Rosen EB, Yom SK, Randazzo J, Drill E, Riedel E, Patel S, Lee NY, Huryn JM, Estilo CL (2017) The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): the Memorial Sloan Kettering Cancer Center experience. Oral Oncol 64:44–51. https://doi.org/10.1016/j.oraloncology.2016.11.015

    Article  PubMed  Google Scholar 

  21. Chang DT, Sandow PR, Morris CG, Hollander R, Scarborough L, Amdur RJ, Mendenhall WM (2007) Do pre-irradiation dental extractions reduce the risk of osteoradionecrosis of the mandible? Head Neck 29:528–536. https://doi.org/10.1002/hed.20538

    Article  PubMed  Google Scholar 

  22. Koga DH, Salvajoli JV, Kowalski LP, Nishimoto IN, Alves FA (2008) Dental extractions related to head and neck radiotherapy: ten-year experience of a single institution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:e1–e6. https://doi.org/10.1016/j.tripleo.2008.01.007

    Article  PubMed  Google Scholar 

  23. Adelstein D, Gillison ML, Pfister DG, Spencer S, Adkins D, Brizel DM, Burtness B, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Eisele DW, Fenton M, Foote RL, Gilbert J, Haddad RI, Hicks WL Jr, Hitchcock YJ, Jimeno A, Leizman D, Lydiatt WM, Maghami E, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rocco J, Rodriguez CP, Shah JP, Weber RS, Witek M, Worden F, Yom SS, Zhen W, Burns JL, Darlow SD (2017) NCCN guidelines insights: head and neck cancers, version 2.2017. J Natl Compr Cancer Netw 15:761–770. https://doi.org/10.6004/jnccn.2017.0101

    Article  Google Scholar 

  24. Wang TH, Liu CJ, Chao TF, Chen TJ, Hu YW (2017) Risk factors for and the role of dental extractions in osteoradionecrosis of the jaws: a national-based cohort study. Head Neck 39:1313–1321. https://doi.org/10.1002/hed.24761

    Article  PubMed  Google Scholar 

  25. Gabric D, Seiwerth S, Baraba A, Vucicevic V and Boras (2017) Mandibular osteonecrosis due to the pulpal-periodontal syndrome: a case report and review of the literature. Acta Stomatol Croat 51:65–71. https://doi.org/10.15644/asc51/1/9

    Article  PubMed  PubMed Central  Google Scholar 

  26. Huang YF, Chang CT, Muo CH, Tsai CH, Shen YF, Wu CZ (2015) Impact of bisphosphonate-related osteonecrosis of the jaw on osteoporotic patients after dental extraction: a population-based cohort study. PLoS One 10:e0120756. https://doi.org/10.1371/journal.pone.0120756

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, Ozsahin EM, Jacobs JR, Jassem J, Ang KK, Lefebvre JL (2005) Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27:843–850. https://doi.org/10.1002/hed.20279

    Article  PubMed  Google Scholar 

  28. Peterson DE, Doerr W, Hovan A, Pinto A, Saunders D, Elting LS, Spijkervet FK, Brennan MT (2010) Osteoradionecrosis in cancer patients: the evidence base for treatment-dependent frequency, current management strategies, and future studies. Support Care Cancer 18:1089–1098. https://doi.org/10.1007/s00520-010-0898-6

    Article  PubMed  Google Scholar 

  29. Guo S, Dipietro LA (2010) Factors affecting wound healing. J Dent Res 89:219–229. https://doi.org/10.1177/0022034509359125

    Article  PubMed  PubMed Central  Google Scholar 

  30. Goldwaser BR, Chuang SK, Kaban LB, August M (2007) Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg 65:2311–2316. https://doi.org/10.1016/j.joms.2007.05.021

    Article  PubMed  Google Scholar 

  31. Huang YF, Chang CT, Liu SP, Muo CH, Tsai CH, Hong HH, Shen YF, Wu CZ (2016) The impact of Oral hygiene maintenance on the association between periodontitis and osteoporosis: a Nationwide population-based cross sectional study. Medicine (Baltimore) 95:e2348. https://doi.org/10.1097/MD.0000000000002348

    Article  PubMed Central  Google Scholar 

  32. Nabil S, Samman N (2012) Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 113:54–69. https://doi.org/10.1016/j.tripleo.2011.07.042

    Article  PubMed  Google Scholar 

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Funding

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW106-TDU-B-212-113004), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10601010036), Chang Gung Memorial Hospital (CMRPG3G0301 and CMRPG3E1341), Far Eastern Memorial Hospital (FEMH-2018-C-049), Taiwan Clinical Trial Consortium for Stroke (MOST106-2321-B-039-005), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

Author information

Authors and Affiliations

  1. Department of General Dentistry, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan

    Yi-Fang Huang

  2. School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan

    Yi-Fang Huang & Chung-Ta Chang

  3. Graduate Institute of Basic Medical Science, China Medical University, No.91, Hsueh-Shih Road, Taichung, 40402, Taiwan

    Shih-Ping Liu

  4. Center for Neuropsychiatry, China Medical University Hospital, Taichung, 40402, Taiwan

    Shih-Ping Liu

  5. Department of Social Work, Asia University, Taichung, 41354, Taiwan

    Shih-Ping Liu

  6. Management Office for Health Data, China Medical University Hospital, Taichung, 40402, Taiwan

    Chih-Hsin Muo

  7. Graduate Institute of Clinical Medicine, China Medical University, Taichung, 40402, Taiwan

    Chun-Hao Tsai

  8. Department of Orthopedics, China Medical University Hospital, Taichung, 40402, Taiwan

    Chun-Hao Tsai

  9. Department of Emergency Medicine, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., Taipei, 22056, Taiwan

    Chung-Ta Chang

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  1. Yi-Fang Huang
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  4. Chun-Hao Tsai
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  5. Chung-Ta Chang
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Corresponding authors

Correspondence to Shih-Ping Liu or Chung-Ta Chang.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Research Ethics Committee of China Medical University and Hospital, Taiwan, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Huang, YF., Liu, SP., Muo, CH. et al. The association between dental therapy timelines and osteoradionecrosis: a nationwide population-based cohort study. Clin Oral Invest 24, 455–463 (2020). https://doi.org/10.1007/s00784-019-02866-4

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  • DOI: https://doi.org/10.1007/s00784-019-02866-4

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