The association with xerostomia from sialadenitis and the jaw osteonecrosis in head and neck cancer population: a nationwide cohort study
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Determine the association between sialadenitis and osteonecrosis of the jaw (ONJ) in head and neck cancer (HNC) patients with varying severity of sialadenitis, treatment modalities, and cancer locations.
Materials and methods
A total of 40,168 HNC patients, including 1907 ONJ subjects and 7559 matched comparisons, were enrolled from a Longitudinal Health Insurance Database for Catastrophic Illness Patients of Taiwan between 2000 and 2006. The association with sialadenitis and ONJ was estimated by logic regression and presented as the odds ratio (OR) and 95% confidence intervals (CIs).
The occurrence of sialadenitis increased the risk of ONJ by 2.55-fold in HNC patients (95% CI = 2.20–2.95). The ONJ incidence was proportion to sialadenitis severity (OR = 2.53 to 4.43). Irradiated HNC patients had a higher tendency to develop jaw necrosis (osteoradionecrosis, ORN) (OR = 5.05, 95% CI = 4.39–5.80). When combined with irradiation exposure, sialadenitis significantly induced the occurrence of ORN (OR = 8.94, 95% CI = 7.40–10.8), especially in oral cancer patients (OR = 15.9 95% CI = 12.5–20.3). The risk of ONJ increased with radiotherapy dosage and duration, except for nasopharyngeal cancer (NPC) patients.
There was a close association between sialadenitis and ONJ in the HNC population. The severity of sialadenitis was positive correlated to ONJ risk. Radiotherapy combined with sialadenitis significantly raised ORN incidence in HNC patients except for NPC patients.
HNC patients complained that xerostomia from sialadenitis might increase the risk to develop ONJ, especially among those who received radiotherapy.
KeywordsSialadenitis Osteonecrosis of the jaw Osteoradionecrosis Radiotherapy Head and neck cancer Population-based
This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037), NRPB Stroke Clinical Trial Consortium (MOST 104-2325-B-039-005), Chang Gung Memorial Hospital (CMRPG3C1791 and CMRPG3E1341), Far Eastern Memorial Hospital (FEMH-2016-C-036), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Research Ethics Committee of China Medical University and Hospital, Taiwan, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study, formal consent is not required.
- 1.Khan AA, Morrison A, Hanley DA, Felsenberg D, LK MC, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, Langdahl BL, Al Dabagh R, Davison KS, Kendler DL, Sandor GK, Josse RG, Bhandari M, El Rabbany M, Pierroz DD, Sulimani R, Saunders DP, Brown JP, Compston J and International Task Force on Osteonecrosis of the J (2015) Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 30:3–23. https://doi.org/10.1002/jbmr.2405 CrossRefPubMedGoogle Scholar
- 2.Hinchy NV, Jayaprakash V, Rossitto RA, Anders PL, Korff KC, Canallatos P, Sullivan MA (2013) Osteonecrosis of the jaw—prevention and treatment strategies for oral health professionals. Oral Oncol 49:878–886. https://doi.org/10.1016/j.oraloncology.2013.06.008 CrossRefPubMedGoogle Scholar
- 7.Huang YF, Chang CT, Muo CH, Tsai CH, Shen YF, Wu CZ (2015) Impact of bisphosphonate-related osteonecrosis of the jaw on osteoporotic patients after dental extraction: a population-based cohort study. PLoS One 10:e0120756. https://doi.org/10.1371/journal.pone.0120756 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Chang CT, Liu SP, Muo CH, Tsai CH, Huang YF (2017) Dental prophylaxis and osteoradionecrosis. J Dent Res 22034516687282. https://doi.org/10.1177/0022034516687282
- 16.Kuo TJ, Leung CM, Chang HS, Wu CN, Chen WL, Chen GJ, Lai YC, Huang WC (2016) Jaw osteoradionecrosis and dental extraction after head and neck radiotherapy: a nationwide population-based retrospective study in Taiwan. Oral Oncol 56:71–77. https://doi.org/10.1016/j.oraloncology.2016.03.005 CrossRefPubMedGoogle Scholar
- 22.Rogers JM, McCaffrey TV (2010) Cummings otolaryngology head and neck surgery, 5th edn. Mosby Elsevier, PhiladelphiaGoogle Scholar
- 23.Sreebny LM, Vissink A (2010) Dry mouth. The malevolent symptom: a clinical guide. Wiley-BlackwellGoogle Scholar
- 26.Corraini P, Heide-Jorgensen U, Schiodt M, Norholt SE, Acquavella J, Sorensen HT, Ehrenstein V (2017) Osteonecrosis of the jaw and survival of patients with cancer: a nationwide cohort study in Denmark. Cancer Med 6:2271–2277. https://doi.org/10.1002/cam4.1173 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Strigari L, Benassi M, Arcangeli G, Bruzzaniti V, Giovinazzo G, Marucci L (2010) A novel dose constraint to reduce xerostomia in head-and-neck cancer patients treated with intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 77:269–276. https://doi.org/10.1016/j.ijrobp.2009.07.1734 CrossRefPubMedGoogle Scholar
- 32.Rivero JA, Shamji O, Kolokythas A (2017) Osteoradionecrosis: a review of pathophysiology, prevention and pharmacologic management using pentoxifylline, alpha-tocopherol, and clodronate. Oral Surg Oral Med Oral Pathol Oral Radiol 124:464–471. https://doi.org/10.1016/j.oooo.2017.08.004 CrossRefPubMedGoogle Scholar
- 33.Barasch A, Cunha-Cruz J, Curro F, DeRouen T, Gilbert GH, Hujoel P, Safford MM, Vena DA, Voinea-Griffin AE, Wu H (2013) Dental risk factors for osteonecrosis of the jaws: a CONDOR case-control study. Clin Oral Investig 17:1839–1845. https://doi.org/10.1007/s00784-012-0880-4 CrossRefPubMedGoogle Scholar
- 35.Hutchinson I (1996) Complications of radiotherapy in the head and neck: an orofacial surgeon’s view. In: Current radiation oncology. Arnold, London, pp 144–177Google Scholar
- 37.Katsura K, Sasai K, Sato K, Saito M, Hoshina H, Hayashi T (2008) Relationship between oral health status and development of osteoradionecrosis of the mandible: a retrospective longitudinal study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:731–738. https://doi.org/10.1016/j.tripleo.2007.10.011 CrossRefPubMedGoogle Scholar