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Tooth Extraction after Radiotherapy

This narrative review discusses the complications associated with tooth extractions in patients undergoing radiotherapy for head and neck cancer, particularly focusing on osteoradionecrosis (ORN), a severe condition that can arise post-treatment. It highlights the increased risk of ORN due to dental extractions and other factors, while also noting the long-term oral complications faced by these patients. The review aims to assess the incidence of ORN related to tooth extraction during and after radiotherapy and identify potential risk factors.

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Mukarram Faridi
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8 views3 pages

Tooth Extraction after Radiotherapy

This narrative review discusses the complications associated with tooth extractions in patients undergoing radiotherapy for head and neck cancer, particularly focusing on osteoradionecrosis (ORN), a severe condition that can arise post-treatment. It highlights the increased risk of ORN due to dental extractions and other factors, while also noting the long-term oral complications faced by these patients. The review aims to assess the incidence of ORN related to tooth extraction during and after radiotherapy and identify potential risk factors.

Uploaded by

Mukarram Faridi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Tooth Extraction after Radiotherapy: When and How?

– A
Narrative Review
Introduction:
- Radiotherapy (RT) is an effective treatment modality for head and neck cancer. It is used for
curative intent, or adjuvant with surgery or as a palliative treatment. It has many complications;
among those is osteoradionecrosis (ORN). ORN is defined as “an exposed necrotic bone for
more than 3 months with no signs of tumor recurrence in the previously irradiated area”.
- Osteoradionecrosis (ORN) of the jaws is the most severe side effect, and in some case
lifethreatening, of radiotherapy for head and neck cancer [1]. Tooth extractions during and after
radiotherapy are the major risk factor of ORN onset, nevertheless the real ORN rate and its risk
factors are still unclear.
- Head and neck cancer generally requires aggressive multimodality treatment using a
combination of surgery and radiotherapy with or without adjuvant chemotherapy. More than
two-thirds of the patients with head and neck cancer present with advanced stage disease
which requires concomitant surgery and radiotherapy.[1-3] Furthermore, radiotherapy has also
been used as a single primary therapy for early stage cancer and for palliative treatment of
highly advanced stage cancer.[4]
- Radiotherapy is largely used for treatment of head and neck cancer, as primary therapy,
adjuvant to surgery, in conjunction with concurrent chemotherapy or as palliative treatment for
late stage and unresectable head and neck malignancies.

Radiotherapy is a treatment modality largely used for head and neck malignancies and although
presents a significant increase in cure rates, it is still associated with several and complex oral
complications.

Radiotherapy is an effective treatment modality for head and neck malignancies. It is used
as single primary therapy for early stage cancer or as adjuvant with surgery, in
conjunction with concurrent chemotherapy or as palliative treatment for unresectable and
highly advanced stage head and neck cancers. Inspite of the fact that radiotherapy has a
good cure rate, patient undergoing Radiotherapy for head and cancer are at lifelong risk of
developing the most severe sequelae and worst complication called as “osteoradionecrosis”
(ORN).
Osteoradionecrosis (ORN) of the jaws is the most devastating dreadful complications of
radiotherapy for head and neck cancer , and a few times it can be at times it can be lifethreatening,
[1].

ORN is a devastating outcome of radiotherapy for head and neck cancer, which is not only difficult to
treat but can also lead to bony deformity. Periodontal diseases, dental caries with periapical pathosis,
functional trauma from dentures, and dental extraction have been implicated in the etiology of ORN.

Tooth extractions during and after radiotherapy are the major risk factor of ORN onset, nevertheless
the real ORN rate and its risk factors are still unclear.

ORN is defned as “an exposed necrotic bone for more than 3 months with no signs of tumour
recurrence in the previously irradiated area”

this latter being considered the most severe sequelae Head and neck cancer patients undergoing RT are
at lifelong risk of developing ORN.

Although the radiotherapy can increase cure rates, the irradiated patient is susceptible to secondary
effects that include mucositis, xerostomia, loss of taste, trismus, progressive periodontal attachment
loss, dental caries (Figure 1), microvascular alteration, soft tissue necrosis and osteoradionecrosis (ORN)
(Regezi et al, 1976; Sulaiman et al, 2003), this latter being considered the most severe sequelae
(Lambert et al, 1997; Thorn et al, 2000; Kanatas et al, 2002; Sulaiman et al, 2003). The main causative
factors of ORN (Figure 2) are bone biopsies, salvage surgery, trauma by prosthesis, dental or periodontal
diseases, and extractions performed before and after radiotherapy (Beumer et al, 1983; Morrish et al,
1981; Epstein et al, 1987; Lambert et al, 1997; Vudiniabola et al, 1999; Oh et al, 2004).

The aim of this systematic review is to assess the incidence of ORN in those patients who
underwent tooth extraction during and after radiotherapy for head and neck cancer and to
identify any possible risk factors

Methods and Materials:


This narrative review focuses on identifying oral complications in Diabetes Mellitus and
the possible pathology leading to these complications. The study was carried out
between March and May 2021. Electronic database search was done using Google
search engine, Google Scholar, PubMed, Science Direct. Reference lists in related
articles were also searched to obtain more articles on the topics. Keywords used to
reach related articles were “Diabetes,” “Oral complications,” “Oral Manifestations in
Diabetes Mellitus,” “Dental Caries,” “Periodontitis,” “Taste alteration,” “Xerostomia,”
“Burning Mouth Syndrome.” Articles and literature on those dating before 2000 and
articles not available in English were excluded from the study. Relevant articles were
hand-searched before being included in the study.

Keywords: Osteoradionecrosis, Dental extraction, Post radiotherapy, Predictors

Tooth Extraction, Post Radiotherapy, Osteonecrosis

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