Tsu-Jen Kuo1, Chung-Man Leung2, Hao-Sheng Chang1, Chao-Nan Wu3, Wei-Li Chen1, Guang-Jhong Chen1, Yu-Cheng Lai4, Wei-Chun Huang5. 1. Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC. 2. Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Taiwan, ROC. 3. Department of Dentistry, Kaohsiung Veterans General Hospital, Taiwan, ROC. Electronic address: tjkuo@vghks.gov.tw. 4. Department of Orthopedics, Kaohsiung Veterans General Hospital, Taiwan, ROC. 5. Section of Critical Care Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC.
Abstract
OBJECTIVES: Osteoradionecrosis of the jaws (ORNJ) is painful for patients and relatively difficult to treat clinically. The high risk of ORNJ for post radiotherapy R/T dental extraction is known; however, many patients still have to have teeth extracted after head and neck R/T. The objective of the present study is to review post R/T dental extraction and determine the ORNJ risk. MATERIALS AND METHODS: We preformed a retrospective cohort study of 1759 patients with head and neck cancer s/p R/T from a random sample of 1,000,000 insurants in the National Health Insurance Research Database during 2000-2013 in Taiwan. Statistical methods included two-proportion Z-test. RESULTS: We evaluated two cohorts: 522 patients with post R/T dental extraction and 1237 patients without post R/T extraction. Overall moderate-to-severe ORNJ after R/T was 2.22% (39/1759), and a total of 39 ORNJ cases were noted during an average of 3.02years (range: 0.62-8.89years, ±2.07). ORNJ prevalence in the overall post R/T extraction-exposed cohort (5.17%, 27/522) was significantly greater than that in the unexposed cohort (0.97%, 12/1237). In a group of patients with ⩽5 post R/T dental extractions (n=373), the ORNJ risk was 2.4% (ORNJ case n=9); in a group of patients with >5 dental extractions (n=149), the ORNJ risk was 12.1% (ORNJ case n=18) (Z-score=4.5062; p-value<0.0001). In the extraction-exposed cohort, the ORNJ risk is higher if the index day to first extraction day was ⩽0.5year (n=103) compared with the group with the index day to first extraction day >0.5year (n=419) (Z-score=-2.1506; p-value=0.0315). CONCLUSION: A tooth extraction time less than half a year after R/T or during the head and neck R/T period, and extraction tooth number ⩽5 would significant lower the ORNJ prevalence.
OBJECTIVES: Osteoradionecrosis of the jaws (ORNJ) is painful for patients and relatively difficult to treat clinically. The high risk of ORNJ for post radiotherapy R/T dental extraction is known; however, many patients still have to have teeth extracted after head and neck R/T. The objective of the present study is to review post R/T dental extraction and determine the ORNJ risk. MATERIALS AND METHODS: We preformed a retrospective cohort study of 1759 patients with head and neck cancer s/p R/T from a random sample of 1,000,000 insurants in the National Health Insurance Research Database during 2000-2013 in Taiwan. Statistical methods included two-proportion Z-test. RESULTS: We evaluated two cohorts: 522 patients with post R/T dental extraction and 1237 patients without post R/T extraction. Overall moderate-to-severe ORNJ after R/T was 2.22% (39/1759), and a total of 39 ORNJ cases were noted during an average of 3.02years (range: 0.62-8.89years, ±2.07). ORNJ prevalence in the overall post R/T extraction-exposed cohort (5.17%, 27/522) was significantly greater than that in the unexposed cohort (0.97%, 12/1237). In a group of patients with ⩽5 post R/T dental extractions (n=373), the ORNJ risk was 2.4% (ORNJ case n=9); in a group of patients with >5 dental extractions (n=149), the ORNJ risk was 12.1% (ORNJ case n=18) (Z-score=4.5062; p-value<0.0001). In the extraction-exposed cohort, the ORNJ risk is higher if the index day to first extraction day was ⩽0.5year (n=103) compared with the group with the index day to first extraction day >0.5year (n=419) (Z-score=-2.1506; p-value=0.0315). CONCLUSION: A tooth extraction time less than half a year after R/T or during the head and neck R/T period, and extraction tooth number ⩽5 would significant lower the ORNJ prevalence.
Authors: Adepitan A Owosho; C Jillian Tsai; Ryan S Lee; Haley Freymiller; Arvin Kadempour; Spyridon Varthis; Adi Z Sax; Evan B Rosen; SaeHee K Yom; Joseph Randazzo; Esther Drill; Elyn Riedel; Snehal Patel; Nancy Y Lee; Joseph M Huryn; Cherry L Estilo Journal: Oral Oncol Date: 2016-12-03 Impact factor: 5.337