Tooth-level predictors of tooth loss and exposed bone after radiation therapy for head and neck cancer
Affiliation:
Adjunct Professor, Department of Periodontics, College of Dentistry, Texas A&M University, Dallas, TX;Adjunct Associate Professor, University of Maryland School of Dental Medicine, Adjunct Assistant Professor, College of Dentistry, The Ohio State University, Prescott, AZ;Professor Emeritus, Department of Periodontics, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO;Private Practice, San Diego, CA;Private Practice, Melbourne, FL;Clinical Assistant Professor of Orthodontics, Department of Orthodontics, University of Washington, Seattle, WA;Clinical Associate Professor of Orthodontics, Department of Orthodontics, University of Washington, Seattle, WA;Assistant Professor of Orthodontics, Department of Orthodontics, University of British Columbia, Vancouver, BC, Canada;Kokich-Shapiro Endowed Professor and Chair, Department of Orthodontics, University of Washington, Seattle, WA;Adjunct Research Professor, Atrium Health, Charlotte, NC;Adjunct Assistant Professor, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA;Private Practice, Kingston, NY
Abstract:
BackgroundThe objective of this study was to identify tooth-level risk factors for use during preradiation dental care management to predict risk of tooth failure (tooth lost or declared hopeless) and exposed bone after radiation therapy (RT) for head and neck cancer (HNC).MethodsThe authors conducted a prospective observational multicenter cohort study of 572 patients receiving RT for HNC. Participants were examined by calibrated examiners before RT and then every 6 months until 2 years after RT. Analyses considered time to tooth failure and chance of exposed bone at a tooth location.ResultsThe following pre-RT characteristics predicted tooth failure within 2 years after RT: hopeless teeth not extracted pre-RT (hazard ratio [HR], 17.1; P < .0001), untreated caries (HR, 5.0; P < .0001), periodontal pocket 6 mm or greater (HR, 3.4; P = .001) or equaling 5 mm (HR, 2.2; P = .006), recession over 2 mm (HR, 2.8; P = .002), furcation score of 2 (HR, 3.3; P = .003), and any mobility (HR, 2.2; P = .008). The following pre-RT characteristics predicted occurrence of exposed bone at a tooth location: hopeless teeth not extracted before RT (risk ratio [RR], 18.7; P = .0002) and pocket depth 6 mm or greater (RR, 5.4; P = .003) or equaling 5 mm (RR, 4.7; P = .016). Participants with exposed bone at the site of a pre-RT dental extraction averaged 19.6 days between extraction and start of RT compared with 26.2 days for participants without exposed bone (P = .21).ConclusionsIndividual teeth with the risk factors identified in this study should be considered for extraction before RT for HNC, with adequate healing time before start of RT.Practical ImplicationsThe findings of this trial will facilitate evidence-based dental management of the care of patients receiving RT for HNC. This clinical trial was registered at Clinicaltrials.gov. The registration number is NCT02057510.
