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Normando AGC, Pérez-de-Oliveira ME, Guerra ENS, Lopes MA, Rocha AC, Brandão TB, Prado-Ribeiro AC, Gueiros LAM, Epstein JB, Migliorati CA, Santos-Silva AR. To extract or not extract teeth prior to head and neck radiotherapy? A systematic review and meta-analysis. Support Care Cancer 2022; 30:8745-8759. [PMID: 35713725 DOI: 10.1007/s00520-022-07215-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/09/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Teeth with poor prognosis are generally recommended to be extracted prior to head and neck radiotherapy (RT) to reduce the risk of developing osteoradionecrosis (ORN), although controversies have been reported. The present systematic review aimed to determine whether tooth extraction prior to head and neck RT may be associated with a reduced risk of developing ORN compared to dental extraction during or after RT. METHODS The review protocol was registered in PROSPERO (CRD42021241631). The review was reported according to the PRISMA checklist and involved a comprehensive search of PubMed, Scopus, Embase, Cochrane Library, LILACS, and Web of Science, in addition to the gray literature. The selection of studies was performed in two phases by two reviewers independently. The risk of bias of individual studies was analyzed using the Joanna Briggs Institute checklist for cross-sectional studies, and the certainty of evidence was assessed using the GRADE tool. RESULTS Twenty-eight observational studies were included in the qualitative synthesis, which showed substantial heterogeneity regarding the association between the timing of tooth extraction and ORN development. Twenty-seven of 28 studies were pooled in a meta-analysis that demonstrated a significant association between an increased risk of ORN and post-RT tooth extraction (odds ratio: 1.98; 95% CI: 1.17-3.35; p = 0.01). CONCLUSION It was confirmed with moderate certainty that dental extractions should be performed prior to the start of head and neck RT to reduce the risk of ORN.
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Affiliation(s)
- Ana Gabriela Costa Normando
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | | | - Eliete Neves Silva Guerra
- Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasilia, Brasilia, DF, Brazil
| | - Márcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - André Caroli Rocha
- Oral Medicine Department, AC Camargo Cancer Center, São Paulo, SP, Brazil.,Clinics Hospital of the Medical School of the University of São Paulo, São Paulo, Brazil
| | - Thaís Bianca Brandão
- Dental Oncology Service, Instituto Do Câncer Do Estado de São Paulo (ICESP-FMUSP), São Paulo, Brazil
| | - Ana Carolina Prado-Ribeiro
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil.,Dental Oncology Service, Instituto Do Câncer Do Estado de São Paulo (ICESP-FMUSP), São Paulo, Brazil
| | - Luiz Alcino Monteiro Gueiros
- Departamento de Clínica E Odontologia Preventiva, Oral Medicine Unit, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Joel B Epstein
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA.,City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil.
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Moore C, McLister C, O'Neill C, Donnelly M, McKenna G. Pre-radiotherapy dental extractions in patients with head and neck cancer: a Delphi study. J Dent 2020; 97:103350. [PMID: 32371021 DOI: 10.1016/j.jdent.2020.103350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To gain a consensus from consultants in restorative dentistry about the types of teeth that should be extracted from head and neck cancer patients (HNC) pre-radiotherapy. MATERIALS Literature- and clinician-informed questionnaires were emailed to an 'expert panel' of consultants (n = 24/28; 86%) in the United Kingdom (UK) and Ireland on three consecutive occasions (Delphi rounds). The results of Round 1 were used to revise the questionnaire that was distributed in Round 2, and this procedure was repeated for Round 3. During Rounds 2 and 3, participants were asked to indicate, on a 5-point Likert scale, their level of agreement with a series of statements on the types of teeth that should be extracted pre-radiotherapy. The target level of consensus for each statement was 70%. RESULTS In Round 2, there was consensus-agreement for 69 of 102 statements (i.e. ≥ 70% of participants rated 'agree' or 'strongly agree' to the relevant statement). Consensus agreement was also achieved for 20 of 28 statements in Round 3. Therefore, a total of 89 consensus statements are presented that illuminate the decision-making process for the pre-radiotherapy extraction of molar, premolar, and anterior teeth with periodontal pocketing, furcation disease, mobility, caries, tooth-wear, apical disease, or other pathology. CONCLUSION The statements represent the consensus professional views of participated consultants in restorative dentistry in the UK and Ireland regarding the types of teeth that should be extracted from HNC patients pre-radiotherapy. The results provide a platform for the development of future guidelines. CLINICAL SIGNIFICANCE Pre-radiotherapy dental assessments for head and neck cancer patients are considered mandatory. This study presents different criteria that should be considered for the treatment planning of these patients in relation to pre-radiotherapy extractions, according to the collective consensus opinion of participated consultants in restorative dentistry in the UK and Ireland.
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Affiliation(s)
- Ciaran Moore
- Restorative Dentistry Department, School of Dentistry, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, United Kingdom; Institute of Clinical Sciences, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital site, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, United Kingdom.
| | - Conor McLister
- Restorative Dentistry Department, School of Dentistry, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, United Kingdom.
| | - Ciaran O'Neill
- Institute of Clinical Sciences, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital site, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, United Kingdom.
| | - Michael Donnelly
- Institute of Clinical Sciences, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital site, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, United Kingdom.
| | - Gerald McKenna
- Restorative Dentistry Department, School of Dentistry, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, United Kingdom; Institute of Clinical Sciences, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital site, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, United Kingdom.
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White JM, Panchal NH, Wehler CJ, Bestgen SC, Colón JE, Desai HG, Hogue CM, Marianne Jurasic M, Maritim BC, Ortega AP, Smith GM, Taylor JY, Gibson G. Department of Veterans Affairs Consensus: Preradiation dental treatment guidelines for patients with head and neck cancer. Head Neck 2019; 41:1153-1160. [DOI: 10.1002/hed.25519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/21/2018] [Accepted: 10/09/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jill M. White
- San Francisco Veterans Affairs Medical Center San Francisco California
| | - Neeraj H. Panchal
- Oral and Maxillofacial SurgeryPhiladelphia Veterans Affairs Medical Center Philadelphia Pennsylvania
- Oral and Maxillofacial SurgeryPenn Presbyterian Medical Center Philadelphia Pennsylvania
- Oral and Maxillofacial SurgeryUniversity of Pennsylvania School of Dental Medicine Philadelphia Pennsylvania
| | - Carolyn J. Wehler
- VA Oral Health Quality GroupEdith Nourse Rogers Memorial Veterans Hospital Bedford Massachusetts
- Boston University Henry M. Goldman School of Dental Medicine Boston Massachusetts
| | | | - José E. Colón
- VHACO Office of Dentistry Washington District of Columbia
| | - Hemal G. Desai
- Corporal Michael J Crescenz VAMC Philadelphia Pennsylvania
| | | | - M. Marianne Jurasic
- Boston University Henry M. Goldman School of Dental Medicine Boston Massachusetts
- Oral Health Quality GroupEdith Nourse Rogers Memorial Veterans Hospital Bedford Massachusetts
| | | | | | | | | | - Gretchen Gibson
- Oral Health Quality GroupVeterans Health Care System of the Ozarks Fayetteville Arkansas
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Kufta K, Forman M, Swisher-McClure S, Sollecito TP, Panchal N. Pre-Radiation dental considerations and management for head and neck cancer patients. Oral Oncol 2018; 76:42-51. [DOI: 10.1016/j.oraloncology.2017.11.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/22/2017] [Accepted: 11/25/2017] [Indexed: 12/20/2022]
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Lalla RV, Long-Simpson L, Hodges JS, Treister N, Sollecito T, Schmidt B, Patton LL, Brennan MT. Clinical registry of dental outcomes in head and neck cancer patients (OraRad): rationale, methods, and recruitment considerations. BMC Oral Health 2017; 17:59. [PMID: 28241807 PMCID: PMC5327511 DOI: 10.1186/s12903-017-0344-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/08/2017] [Indexed: 01/25/2023] Open
Abstract
Background Most head and neck (H&N) cancer patients receive high-dose external beam radiation therapy (RT), often in combination with surgery and/or chemotherapy. Unfortunately, high-dose RT has significant adverse effects on the oral and maxillofacial tissues, some of which persist for the life of the patient. However, dental management of these patients is based largely on individual and expert opinion, as few studies have followed patients prospectively to determine factors that predict adverse oral sequelae. In addition, many previous studies were conducted before wide-spread adoption of intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. The objective of this multi-center study is to systematically evaluate the oral health of subjects for 2 years after commencement of RT, with the goal of identifying risk factors that predict adverse oral outcomes post-RT. Methods This is a prospective multi-center longitudinal cohort study of H&N cancer patients who receive high-dose RT with curative intent. Planned enrollment is 756 subjects at 6 primary clinical sites (and their affiliated sites) in the USA. A baseline visit is conducted prior to the beginning of RT. Follow-up visits are conducted at 6, 12, 18 and 24 months from the start of RT. The primary outcome measure is the 2-year rate of tooth loss in patients who have received at least one session of external beam RT for H&N cancer. Secondary outcome measures include the incidence of exposed intraoral bone; incidence of post-extraction complications; change in Decayed Missing and Filled Surfaces (DMFS); change in periodontal measures; change in stimulated whole salivary flow rates; change in mouth opening; topical fluoride utilization; chronic oral mucositis incidence; changes in RT-specific quality of life measures; and change in oral pain scores. Discussion This study will contribute to a better understanding of the dental complications experienced by these patients. It will also enable identification of risk factors associated with adverse outcomes such as tooth loss and osteoradionecrosis. These findings will support the development of evidence-based guidelines and inform the planning of future interventional studies, with the goal of advancing improvements in patient care and outcomes. Trial registration ClinicalTrials.gov Identifier NCT02057510, registered 5 February 2014.
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Affiliation(s)
- Rajesh V Lalla
- Section of Oral Medicine, MC1605, University of Connecticut Health, 263, Farmington Avenue, Farmington, CT, 06030-1605, USA.
| | - Leslie Long-Simpson
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA
| | - James S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA, 02120, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Thomas Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA, 19104, USA
| | - Brian Schmidt
- Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, New York, NY, 10010, USA
| | - Lauren L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, CB 7450, USA
| | - Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
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Hallmer F, Bjørnland T, Andersson G, Becktor JP, Kristoffersen AK, Enersen M. Bacterial diversity in medication-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:436-444. [PMID: 28159588 DOI: 10.1016/j.oooo.2016.11.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/17/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim was to study the association between microflora and medication-related osteonecrosis of the jaw (MRONJ) by using culture-independent molecular techniques to detect bacteria in necrotic bone lesions. STUDY DESIGN Included were 18 consecutive patients with MRONJ, 10 with osteoporosis and 8 cancer patients. Bone biopsies were retrieved from the center of the necrotic bone and from visually healthy bone, and 16 S rRNA gene fragments from bacterial DNA were amplified with polymerase chain reaction. RESULTS The study revealed a diversity of bacteria represented by 16 S rRNA sequences in all the necrotic bone samples and in 60% of the visually healthy bone. Eight dominating taxa groups were identified at the genus level: Porphyromonas, Lactobacillus, Tannerella, Prevotella, Actinomyces, Treponema, Streptococcus, and Fusobacterium. CONCLUSIONS The necrotic bone lesions contained mainly anaerobic bacteria, representative of periodontal microflora, suggesting that a periodontal infection in combination with antiresorptive treatment could initiate osteonecrosis.
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Affiliation(s)
- Fredrik Hallmer
- Consultant, Department of Oral and Maxillofacial Surgery, Skåne University Hospital, Lund, Sweden; Department of Oral and Maxillofacial Surgery, Malmö University, Faculty of Odontology, Malmö, Sweden.
| | - Tore Bjørnland
- Professor and Chairman, Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Gunilla Andersson
- Associate Professor, Department of Oral and Maxillofacial Surgery, Malmö University, Faculty of Odontology, Malmö, Sweden
| | - Jonas P Becktor
- Associate Professor and Head, Department of Oral and Maxillofacial Surgery Malmö University, Faculty of Odontology, Malmö, Sweden
| | - Anne K Kristoffersen
- Senior Engineer, Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Morten Enersen
- Associate Professor, Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Duchnay M, Tenenbaum H, Wood R, Raziee HR, Shah PS, Azarpazhooh A. Interventions for preventing osteoradionecrosis of the jaws in people receiving head and neck radiotherapy. Hippokratia 2015. [DOI: 10.1002/14651858.cd011559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Michael Duchnay
- University of Toronto; Faculty of Dentistry; Suite 511 124 Edward Street Toronto ON Canada M5G 1G6
| | - Howard Tenenbaum
- University of Toronto; Faculty of Dentistry; Suite 511 124 Edward Street Toronto ON Canada M5G 1G6
| | - Robert Wood
- Princess Margaret Hospital, University Health Network; Department of Dental Oncology, Ocular and Maxillofacial Prosthetics; 610 University Avenue Toronto ON Canada M5G 2M9
| | - Hamid Reza Raziee
- Princess Margaret Hospital, University of Toronto; Department of Radiation Oncology, Faculty of Medicine; 610 University Avenue Toronto ON Canada M5G 2M9
| | - Prakeshkumar S Shah
- University of Toronto Mount Sinai Hospital; Department of Paediatrics and Health Policy, Management and Evaluation; 600 University Avenue Toronto ON Canada M5G 1XB
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto; Discipline of Dental Public Health, Discipline of Endodontics; 515-C, 124 Edward St Toronto ON Canada M5G 1G6
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Eliyas S, Al-Khayatt A, Porter RWJ, Briggs P. Dental extractions prior to radiotherapy to the jaws for reducing post-radiotherapy dental complications. Cochrane Database Syst Rev 2013; 2013:CD008857. [PMID: 23450590 PMCID: PMC8947952 DOI: 10.1002/14651858.cd008857.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Radiotherapy as part of head and neck cancer treatment leaves patients requiring much dental rehabilitation in a compromised environment that is difficult for the patient and the dental team to manage. OBJECTIVES To assess the effects of maintaining the patient's natural dentition during radiotherapy in comparison to extracting teeth before radiotherapy in areas that are difficult to access by the patient and the dentist, should reduction in mouth opening occur after radiotherapy to the jaws. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 22 November 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 11), MEDLINE via OVID (1946 to 22 November 2012), EMBASE via OVID (1980 to 22 November 2012), CANCERLIT via PubMed (1950 to 22 November 2012), CINAHL via EBSCO (1980 to 22 November 2012) and reference lists of articles. We advertised for currently ongoing studies via the Cochrane Oral Health Group website and the Cochrane Oral Health Group Twitter feed. SELECTION CRITERIA Randomised controlled trials comparing extraction of teeth prior to radiotherapy with leaving teeth in situ during radiotherapy to the jaws. DATA COLLECTION AND ANALYSIS Three review authors independently assessed the results of the searches for inclusion in the review. MAIN RESULTS No randomised controlled trials were found. AUTHORS' CONCLUSIONS There are no randomised controlled trials to assess the effect of extracting teeth prior to radiotherapy compared to leaving teeth in the mouth during radiotherapy to the jaws.
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Affiliation(s)
- Shiyana Eliyas
- Charles Clifford Dental Hospital, Sheffield Teaching Hospital, Sheffield,
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Lawrence M, Aleid W, McKechnie A. Access to dental services for head and neck cancer patients. Br J Oral Maxillofac Surg 2012; 51:404-7. [PMID: 23127589 DOI: 10.1016/j.bjoms.2012.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/12/2012] [Indexed: 11/27/2022]
Abstract
Dental assessment is important for patients with cancer of the head and neck who are to have radiotherapy, as many of these patients have poor dental health before they start treatment. This, compounded by the fact that radiotherapy to the head and neck has a detrimental effect on oral health, has led the National Institute for Clinical Excellence (NICE) to issue guidance that the dental health of these patients should be assessed before treatment. Unfortunately some multidisciplinary teams, such as the one at United Lincolnshire Hospitals, do not have access to a restorative dentist or a dental hygienist. In a retrospective survey we investigated access to general dental services by patients with head and neck cancer who were to have radiotherapy at our hospital and found that 37/71 (52%) had not been reviewed by a dentist within the past 12 months. A secondary national survey that investigated the availability of restorative dental and dental hygienic services showed that of the 56 multidisciplinary teams that deal with head and neck cancer in England, 19 (34%) do not have access to a restorative dentist and 23 (41%) do not have access to a dental hygienist, suggesting that this problem may be countrywide.
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Affiliation(s)
- Mark Lawrence
- OMFS Department, Clinic 9, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, United Kingdom.
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Rolim AEH, Costa LJD, Ramalho LMP. Repercussões da radioterapia na região orofacial e seu tratamento. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000600011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A radioterapia em região de cabeça e pescoço provoca inúmeras sequelas ao paciente irradiado, afetando o sistema estomatognático e com repercussões sistêmicas importantes. As sequelas da radiação ionizante podem ser extensas e, algumas vezes, permanentes, em especial nas glândulas salivares e no tecido ósseo. É relevante que o cirurgião dentista tenha conhecimento das reações adversas e das formas adequadas de prevenção e tratamento para amenizar o desconforto e melhorar a condição de vida do paciente irradiado. Portanto, a conscientização e motivação deste paciente, com a promoção de saúde oral através da adequação do meio bucal e orientações sobre ações preventivas, são essenciais para se obter o melhor prognóstico.
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Rosales ACDMN, Esteves SCB, Jorge J, Almeida OPD, Lopes MA. Dental needs in brazilian patients subjected to head and neck radiotherapy. Braz Dent J 2009; 20:74-7. [PMID: 19466236 DOI: 10.1590/s0103-64402009000100013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In spite of its recognized benefits in the treatment of malignant tumors, radiation therapy have several side effects in the head and neck region. The evaluation of oral conditions by a dentist is important to prevent or minimize these problems. The aim of this retrospective review was to analyze the dental needs in 357 patients who received radiotherapy in the head and neck region and were treated at Orocentro/FOP/UNICAMP, between January 1990 and December 2004. Review of patient files showed that dental examination before radiotherapy was not performed in 148 patients (41.5%) and was done in 209 patients (58.5%). From the total of examined patients, 94 (45%) did not require dental procedures at the moment of examination, while 115 (55%) presented some sort of dental need. Following the patients after the radiotherapy, it was observed that the group of patients that was evaluated before radiation presented less need of restorations, root canal filling and dental extractions than those who were not evaluated. The results of this study confirm that the evaluation of oral conditions prior to radiotherapy is essential to minimize the dental needs, emphasizing the importance of the dentist in the multidisciplinary team that treats cancer patients.
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Katsura K, Sasai K, Sato K, Saito M, Hoshina H, Hayashi T. Relationship between oral health status and development of osteoradionecrosis of the mandible: A retrospective longitudinal study. ACTA ACUST UNITED AC 2008; 105:731-8. [DOI: 10.1016/j.tripleo.2007.10.011] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 09/27/2007] [Accepted: 10/05/2007] [Indexed: 12/01/2022]
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Sulaiman F, Huryn JM, Zlotolow IM, Zlotolow IM. Avulsions dentaires chez les patients irradiés de la tête et du cou : une étude rétrospective du Memorial Sloan-Kettering Cancer Center (MSKCC). ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s0035-1768(04)72331-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sulaiman F, Huryn JM, Zlotolow IM. 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 2003; 61:1123-31. [PMID: 14586845 DOI: 10.1016/s0278-2391(03)00669-4] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study was designed to use our institutional experience with irradiated head and neck patients to evaluate 1) dental extraction incidence and sequelae; 2) those patients who developed osteoradionecrosis via extraction and the efficacy of hyperbaric oxygen therapy; and 3) guidelines for extraction protocols in this population. Materials and methods A group of 1,194 patients with a history of radiation to the head and neck, who were evaluated and treated in the Dental Service at Memorial Sloan-Kettering Cancer Center, were reviewed. The 187 who required dental extractions were analyzed using patient demographics, tumor location, staging, histopathology, radiation dosage, field, and timing, dental extraction indications, location, surgical methods, and sequelae. RESULTS Almost 85% of the patients reviewed did not require extraction. Only 4 of those who underwent extractions at Memorial Sloan-Kettering Cancer Center developed osteoradionecrosis. CONCLUSIONS The use of multidisciplinary team communications and careful extraction selection by prognosis and symptomatology regardless of preexisting dental pathologies, atraumatic extraction procedures, and meticulous follow-up can lower both extraction and osteoradionecrosis rates.
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Affiliation(s)
- Frankie Sulaiman
- Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA
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Cramer CK, Epstein JB, Sheps SB, Schechter MT, Busser JR. Modified Delphi survey for decision analysis for prophylaxis of post-radiation osteonecrosis. Oral Oncol 2002; 38:574-83. [PMID: 12167435 DOI: 10.1016/s1368-8375(01)00115-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES to augment epidemiological data from the literature, assist Bayesian perspectives and a decision analytic framework for the minimization of post-radiation osteonecrosis (PRON; osteoradionecrosis) and its impacts in irradiated head and neck cancer patients. MATERIALS AND METHODS a modified Delphi process survey of 15 international clinical experts was used to identify and assess outcome data and factors related to PRON risk, extraction, and factor suitability for formal decision analysis. Clinimetric pain and function outcome scales were created and assessed for relevance to quality of life. RESULTS AND CONCLUSIONS expert opinion qualitative assessments were generally adequate and consistent between open- and close-ended items, but many quantitative (e.g. PRON risk rate) estimates were not. A research agenda advocated to validate the epidemiological database for minimization of PRON and decision analysis includes: adoption of a uniform definition of PRON, and ICD code for non-experimental databases; more detailed, consistent data reporting in articles; and quality of life studies.
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Affiliation(s)
- Carl K Cramer
- Department of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Avenue, BC, Vancouver, Canada.
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