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Dental loss after radiotherapy for head and neck cancer

British Dental Journal volume 231, pages 473–478 (2021)Cite this article

Abstract

Introduction In radiotherapy (RT) for head and neck cancer (HNC), dental morbidity is significant and it may result in loss of the dentition following treatment.

Aims The aim of this clinical study is to identify the incidence of tooth loss over time and correlate this to the RT dose and various risk factors in patients with HNC treated with radical RT.

Design A retrospective observational study.

Materials and methods The records of 1,118 patients with HNC treated with radical or adjuvant RT from January 2010 to December 2019 were analysed. After applying strict inclusion criteria, 78 patients with 1,566 individual tooth data were selected. RT dose mapping was performed for each tooth.

Results A total of 253 teeth (16.2%) were extracted. The following risk factors were significant: gender (p = 0.0001), xerostomia (p <0.0001), RT dose (p <0.0001) and smoking (p <0.0001). Non-significant factors were age, RT delivery technique and the addition of cisplatin.

Conclusion Detailed RT dose mapping was used to identify RT dose as a risk factor for dental loss. Careful pre-RT dental treatment and minimisation of RT dose to teeth and salivary glands is required to prevent or reduce the loss of dentition.

Key points

  • Identifies specific risk factors for tooth loss in a cohort of post-radiotherapy patients.

  • Aims to improve recognition and awareness of the condition which has an increasing incidence in post-radiotherapy patients.

  • This study is innovative in the degree of radiotherapy dose-mapping for individual teeth.

  • Reflects the need for specialised dental aftercare in these post-radiotherapy patients, at a level not currently provided.

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Authors and Affiliations

  1. Institute of Dentistry and Oral Sciences, Palacky University, Olomouc, Czech Republic

    Josef Paul Kovarik & Iva Voborna

  2. Dental Hospital, Newcastle upon Tyne, UK

    Stewart Barclay & Ailsa Nicol

  3. Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK

    Charles Kelly, Muhammad Shahid Iqbal & Josef Kovarik

  4. Palacky University, Olomouc, Czech Republic

    Petr Daniel Kovarik

Authors
  1. Josef Paul Kovarik
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  2. Iva Voborna
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  3. Stewart Barclay
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  4. Ailsa Nicol
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  5. Charles Kelly
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  6. Petr Daniel Kovarik
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  7. Muhammad Shahid Iqbal
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Corresponding author

Correspondence to Josef Kovarik.

Ethics declarations

The authors do not declare any conflict of interest. This retrospective study was registered with the local hospital clinical effectiveness register as a service review project (project number 9698). The data used in this study were obtained from the previous clinical practice and the patient's identification and personal information was protected anonymously. The Chair of Newcastle and North Tyneside 1 Research Ethics Committee confirmed ethical approval was not required. The authors followed the local institutional ethical protocols.

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Kovarik, J., Voborna, I., Barclay, S. et al. Dental loss after radiotherapy for head and neck cancer. Br Dent J 231, 473–478 (2021). https://doi.org/10.1038/s41415-021-3536-4

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  • DOI: https://doi.org/10.1038/s41415-021-3536-4

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