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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Code availability
The authors state that no codes or algorithms were used in the manuscript under consideration.
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Acknowledgements
The authors would like to gratefully acknowledge the Oral Care Study Group of the Multinational Association of Supportive Care in Cancer (MASCC) for the careful manuscript review, especially Dr. Derek K. Smith from the Vanderbilt University Medical Center, Nashville TN, USA, Dr. Cherry L. Estilo from the Memorial Sloan Kettering Cancer Center, New York, NY, USA, and Dr. Erin Watson from Princess Margaret Cancer Centre, Toronto, ON, Canada. Also, the authors would like to thank the São Paulo State Research Foundation (FAPESP 2019/26676-7, 2019/09692-9, and 2018/02233-6) and the Brazilian National Council for Scientific and Technological Development (CNPq) for Dr. Alan R. Santos-Silva funding.
Consortium data
Consortium name
Oral Care Study Group of the Multinational Association of Supportive Care in Cancer (MASCC). Website: https://www.mascc.org/oral-care
Contact details (consortia representative)
Dr. Derek K. Smith, Vanderbilt University Medical Center, Nashville TN, USA
2525 West End Avenue. Room/Suite 1141, Nashville, TN, 37203
Telephone: (615) 322-1895
E-mail: derek.k.smith@vumc.org
Consortium members
Cherry L. Estilo1, David Yang2, Deborah Saunders3, Erin Watson4
1Memorial Sloan Kettering Cancer Center, New York, NY, USA; 2Provincial Practice Leader in Oral and Maxillofacial Surgery for the BC Cancer Agency, Canada; 3Health Sciences North, Northeast Cancer Centre, Sudbury, Ontario, Canada and the Northern Ontario School of Medicine, Sudbury, Ontario, Canada; 4Princess Margaret Cancer Centre, Toronto, ON, Canada
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The members of the consortium previously requested to not have author status; therefore, the group members were not included in the author’s list. The authors thanked the consortium for its contribution in the acknowledgements section.
Funding
This work was supported by Sao Paulo Research Foundation (FAPESP, Brazil) processes number 2019/26676–7 and 2019/09692–9 (PhD scholarships granted to Ana Gabriela C. Normando), and 2018/02233–6 (research grants given to Dr. Alan Roger Santos-Silva). The Brazilian National Council for Scientific and Technological Development (CNPq, Brazil) supports Dr. Alan R. Santos-Silva, Eliete Guerra, and Marcio Lopes as research grantees. None of the authors received research support from companies or similar organizations that may gain or lose financially through publication of this manuscript.
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All authors contributed to the study conception and design. Study design was performed by MAL, ACR, TBB, ACPR, and LAMG. Material preparation was performed by JBE and CAM, data collection was performed by AGCN and MEP, and analysis was performed by AGCN and ENSG. The first draft of the manuscript was written by AGCN and ARSS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Normando, A.G.C., Pérez-de-Oliveira, M.E., Guerra, E.N.S. et al. To extract or not extract teeth prior to head and neck radiotherapy? A systematic review and meta-analysis. Support Care Cancer 30, 8745–8759 (2022). https://doi.org/10.1007/s00520-022-07215-y
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DOI: https://doi.org/10.1007/s00520-022-07215-y