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Association between tooth extraction during radiotherapy and the risk of osteoradionecrosis in patients with head and neck cancers

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

It is commonly recommended that tooth extraction should be performed prior to radiotherapy (RT) in patients with head neck cancer to prevent osteoradionecrosis (ORN). However, doctors still occasionally encounter patients who require tooth extraction during RT. This study aimed to determine the risk of ORN in patients who undergo tooth extraction during RT.

Methods

Data were collected from Taiwan's National Health Insurance Research Database. We retrospectively enrolled 24,412 patients with head and neck cancer treated with radiotherapy between 2011 and 2017. The associations between ORN and demographic characteristics, timing of tooth extraction, and treatments were examined using univariate and multivariable Cox proportional hazards regression models.

Results

A total of 24,412 head and neck cancer patients were enrolled; 133 patients underwent tooth extraction during RT and 24,279 patients did not undergo tooth extraction during RT. Tooth extraction during RT was not associated with a significantly higher risk of ORN (hazard ratio [HR] = 1.303, P = 0.4862). Tumor site, RT dose ≥ 60 Gy, age < 55 y/o, mandibulectomy, chronic periodontitis, and chemotherapy were significantly associated with a higher risk of ORN.

Conclusion

The risk of ORN in head and neck cancer is not significantly different between patients who undergo tooth extraction during RT and patients who do not undergo tooth extraction during RT.

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Availability of data and materials

Data are obstained from the National Health Insurance Research Database (NHIRD).

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Funding

The authors report no commercial, proprietary or financial interest in the products or companies mentioned in this article.

Author information

Author notes

  1. Pei-Hsun Liao, Che Lin have contributed equally to this work.

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Pei-Hsun Liao

  2. School of Medicine, National Defense Medical Center, Taipei, Taiwan

    Pei-Hsun Liao

  3. Department of Orthopaedic, Shuang Ho Hospital, New Taipei City, Taiwan

    Che Lin

  4. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Jing-Yang Huang

  5. Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan

    Jing-Yang Huang

  6. Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan

    Hsin-Mei Lin & Tsu-Jen Kuo

  7. School of Dentistry, Chung Shan Medical University, 110, Sec. 1, Chien-Kuo N. Rd., Taichung, Taiwan

    Tsu-Jen Kuo

  8. Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung, Taiwan

    Tsu-Jen Kuo

  9. Eternal Dental Clinic, Taichung, Taiwan

    Tsu-Jen Kuo

Authors
  1. Pei-Hsun Liao
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  2. Che Lin
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  4. Hsin-Mei Lin
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Contributions

P-HL: conceptualization, investigation, methodology, project administration, validation, and writing—original draft and editing. CL: conceptualization, data curation, formal analysis, investigation, resources, writing—original draft, and editing. J-YH: data curation, formal analysis, software. H-ML: conceptualization, data curation, resources. T-JK: conceptualization, investigation, methodology, project administration, supervision, validation, visualization, and writing—review and editing.

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Correspondence to Tsu-Jen Kuo.

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Liao, PH., Lin, C., Huang, JY. et al. Association between tooth extraction during radiotherapy and the risk of osteoradionecrosis in patients with head and neck cancers. Eur Arch Otorhinolaryngol 280, 2945–2952 (2023). https://doi.org/10.1007/s00405-023-07885-2

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  • DOI: https://doi.org/10.1007/s00405-023-07885-2

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