Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review
ABSTRACT This systematic review aims to identify and review the best available evidence to answer the clinical question 'What are the incidence and the factors influencing the development of osteoradionecrosis after tooth extraction in irradiated patients?'. A systematic review of published articles on post-irradiation extraction was performed via electronic search of the Medline, Ovid, Embase and Cochrane Library databases. Additional studies were identified by manual reference list search. Evaluation and critical appraisal were done in 3 stages by two independent reviewers and any disagreement was resolved by discussion with a third party. 19 articles were selected for the final analysis. The total incidence of osteoradionecrosis after tooth extraction in irradiated patients was 7%. When extractions were performed in conjunction with prophylactic hyperbaric oxygen, the incidence was 4% while extraction in conjunction with antibiotics gave an incidence of 6%. This systematic review found that while the incidence of osteoradionecrosis after post-irradiation tooth extractions is low, the extraction of mandibular teeth within the radiation field in patients who received a radiation dose higher than 60Gy represents the highest risk of developing osteoradionecrosis. Based on weak evidence, prophylactic hyperbaric oxygen is effective in reducing the risk of developing osteoradionecrosis after post-radiation extractions.
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ABSTRACT: Osteoradionecrosis of jaws (ORNJ) is a serious complication of radiotherapy for patients with head and neck cancer. As of yet, no universally accepted treatment exists for this chronic pathologic condition. It has been shown that ultrasound is an effective, noninvasive adjunctive therapy in ORNJ, as ultrasound can result in the increase of angiogenesis and bone production, which are essential for ORNJ healing. Recently, low-frequency ultrasound has been demonstrated to enhance the transdermal delivery of macromolecules and hydrophilic drugs (low-frequency sonophoresis, LFS). As a biological macromolecule, basic fibroblast growth factor (bFGF) also has potential osteoinductive and angiogenic properties. Herein, we present a hypothesis that LFS-mediated transdermal bFGF delivery is capable of improving the healing of ORNJ and will be a new effective adjunctive therapy to surgery. This treatment combines low-frequency ultrasound with bFGF to respectively promote vascularly compromised bone and soft tissue wound healing, and is expected to be more effective than ultrasound therapy alone.Iranian Journal of Medical Hypotheses and Ideas 01/2014; 9(1). DOI:10.1016/j.jmhi.2014.07.001
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ABSTRACT: PURPOSE: To evaluate the severity of post-radiation dental lesions and possible correlation with radiation dose to the teeth in patients treated for head and neck cancers. METHODS AND MATERIALS: Data from 93 head and neck radiotherapy patients treated between 1997 and 2008 were analyzed retrospectively. The main effect, radiation dose to the individual teeth, was evaluated with covariates of elapsed time after radiation, xerostomia, topical fluoride use, and oral hygiene status included. Patients' radiotherapy plans were used to calculate cumulative exposure for each tooth. Patients' teeth were evaluated using a validated index and then categorized as having none/slight or moderate/severe post-radiation damage. RESULTS: Patients (31 females, 62 males) ranged in age from 18-82 yrs (mean=57). The number of teeth/patient ranged from 3-30 (mean=20) with a total of 1873 teeth evaluated. Overall, 51% of teeth had moderate/severe damage, with the remaining having little or none. Using odds ratios and 95% confidence intervals, the odds for moderate/severe damage were 2-3x greater for teeth exposed to between 30-60 Gy as compared to no radiation. However, for teeth exposed to ≥60 Gy as compared to no radiation the odds of moderate/severe tooth damage was greater by a magnitude of 10 times. CONCLUSIONS: The results indicate that there is minimal tooth damage below 30 Gy (salivary gland threshold), a greater than 1:1 increased dose-response between 30-60y likely related to salivary gland damage, and a critical threshold of ≥60Gy which may be linked to direct effects of radiation on tooth structure. These findings suggest that care should be taken during the treatment planning process to limit tooth dose, and when clinically possible to limit tooth dose to less than 60 Gy.07/2011; 1(3):142-148. DOI:10.1016/j.prro.2011.03.003
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ABSTRACT: Head-neck radiotherapy is accompanied by a life-long risk of developing severe oral problems. This study retrospectively assessed oral foci detected during pre-radiation dental screening and follow-up in order to assess risk factors for developing oral problems after radiotherapy. Charts of 185 consecutive head-neck cancer patients, subjected to a pre-radiation dental screening in the University Medical Center Groningen, the Netherlands, between January 2004 and December 2008 were reviewed. Eighty (partially) dentulous patients scheduled for curative head-neck radiotherapy met the inclusion criteria. Oral foci were found in 76% of patients, predominantly periodontal disease. Osteoradionecrosis had developed in 9 out of 80 patients (11%). Overall, patients presenting with periodontal pockets ≥ 6mm at dental screening had an increased risk (19%) of developing osteoradionecrosis compared to the total group of patients. Patients in whom periodontal disease treatment was composed of initial periodontal in stead of removal of the affected teeth, the risk of developing osteoradionecrosis was even higher, viz. 33%. A worse periodontal condition at dental screening and initial periodontal therapy to safeguard these patients to develop severe oral sequelae after radiotherapy were shown to be major risk factors of developing osteoradionecrosis.Radiotherapy and Oncology 12/2011; 101(3):403-9. DOI:10.1016/j.radonc.2011.09.018