Do pre-irradiation dental extractions reduce the risk of osteoradionecrosis of the mandible?
BACKGROUND
This study was done to determine if pre-radiotherapy (pre-RT) dental extractions reduce the risk of osteoradionecrosis (ORN).


METHODS
Between 1987 and 2004, 413 patients with oropharyngeal carcinomas were treated with definitive RT at the University of Florida. Dentate patients underwent pretreatment dental evaluation. Teeth in the RT field were usually extracted if thought to have poor long-term prognosis from dental disease. The endpoint was > or = grade 2 ORN using a modified staging system. Patients were excluded for local recurrence, additional RT above the clavicles, or head and neck surgery besides neck dissection.


RESULTS
ORN rates were as follows: edentulous, <1%; teeth in-field with pre-RT extractions, 15%; and teeth in-field without pre-RT extractions, 9%. Patients with poor in-field teeth and pre-RT extractions had a higher 5-year incidence of ORN than those who did not have pre-RT extractions (16% vs 6%, p = .48). Likewise, for those with in-field teeth in good condition and pre-RT extractions, the 5-year ORN incidence was higher than for those who did not undergo extractions (15% vs 2%, p = .42). Multivariate analysis revealed increased ORN risk with doses of >70 Gy, once-daily fractionation, or brachytherapy.


CONCLUSIONS
Pre-RT extractions do not appear to reduce the risk of ORN.
Chang
Daniel T
DT
Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA.
Sandow
Pamela R
PR
Morris
Christopher G
CG
Hollander
Rachel
R
Scarborough
Lauren
L
Amdur
Robert J
RJ
Mendenhall
William M
WM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D015999:Multivariate Analysis; D009909:Oral Health; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D010025:Osteoradionecrosis / Q000209:etiology / Q000517:prevention & control*; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D014081:Tooth Extraction; D016896:Treatment Outcome