Caution on Dental Extractions Post-Radiation for Head and Neck Cancer

 A recent study found higher incidences of exposed bone and osteoradionecrosis in patients with head and neck cancer who underwent dental extractions soon after radiotherapy, with the risk particularly elevated in those who received higher radiation doses.

METHODOLOGY:

• Guidelines recommend removing nonrestorable teeth before radiation therapy to prevent osteoradionecrosis in patients with head and neck cancer, but this can delay treatment by 2-4 weeks, potentially affecting overall survival. An alternative is to perform extractions after radiation, with a caveat that radiation can affect patients' oral health following an extraction.
• Prospective data assessing outcomes among patients receiving extractions soon after radiation therapy — when complications may be more minimal — don't exist.
• Researchers evaluated the safety of performing dental extractions within 4 months of radiation therapy and the associated risks for exposed bone and osteoradionecrosis.
• The study included 50 patients with head and neck cancer, enrolled from January 2020 to September 2022.
• The primary outcome was the cumulative incidence of exposed bone; secondary outcomes were the incidence of osteoradionecrosis and adherence to recommended post-radiation extractions. The median follow-up period was 26 months.

TAKEAWAY:

• A total of 30 patients had between 1 and 28 extractions at a median of 64.5 days (range, 13-152 days) after therapy, while 20 patients declined extractions. Out of those who had extractions, 26 patients had them performed within the recommended 4-month window following radiation therapy.
• Among all patients, 13 experienced an exposed bone event, 12 of which occurred in patients who had post-radiation extractions; 8 of 13 patients with exposed bone were later diagnosed with osteoradionecrosis.
• The 2-year cumulative incidences of exposed bone were 27%, 40%, and 7% among all patients, those who underwent extractions, and those who declined extractions, respectively. The 2-year cumulative incidences of osteoradionecrosis were 18%, 23%, and 7% among all patients, those who underwent extractions, and those who declined extractions, respectively.
• Among patients who received post-radiation extractions, a mean oral cavity dose ≥ 35 Gy was associated with greater risk for exposed bone at 2 years (58%) and osteoradionecrosis (39%). An average mandible dose ≥ 31.5 Gy produced similar results.

IN PRACTICE:

Post-radiation extractions, even when performed soon after the completion of radiation therapy, are "unsuitable for routine use," particularly at high oral cavity or mandibular doses, given the risk for exposed bone and osteoradionecrosis, the authors concluded. 

SOURCE:

The study, with Matthew C. Ward, MD, from Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, was published online in JAMA Otolaryngology–Head & Neck Surgery.

LIMITATIONS:

The study had a small sample size, limited generalizability, and a short follow-up. Confounding factors could have affected the results.

DISCLOSURES:

The study funding source was not declared. Several authors received grants and personal fees outside this work.

https://www.medscape.com/viewarticle/are-dental-extractions-post-radiation-head-and-neck-cancer-2024a1000g44