title: Risk-adapted dental care prior to intensity-modulated radiotherapy (IMRT).
abstract: BACKGROUND
  At the Clinic for Radiation Oncology at the Zurich University Hospital (UniversitätsSpital Zürich [USZ]), head-and-neck tumor (HNT) patients have been treated with intensity-modulated radiotherapy (IMRT) since 01/2002 (n 〉 800). This method causes less damage to normal tissues adjacent to the tumor, and thus it was possible in the head/neck region to markedly reduce the rate of osteoradionecrosis (ORN), in addition to reducing the rate of severe xerostomia. Based on these results, risk-adapted dental care (RaDC) was adopted by our clinic as the standard mode of pre-IMRT dental treatment. The guidelines as formulated by Grötz et al. were respected. ORN prophylaxis is one of the most important goals of pre-radiotherapy dental care, and the ORN rate is a measurable parameter for the efficacy of dental care, given a certain radiation technique. The aim of the present study was therefore to evaluate the efficacy of RaDC as reflected by the ORN rate of our IMRT patients.
  
  
  METHODS
  IN August 2006, RaDC was clinically implemented and has been used for all HNT patients prior to IMRT since then. Before that (01/2002-07/2006), dental restorations were performed according to the usual procedure.
  
  
  RESULTS
  The rate of grade-2 ORN was similar in the conventionally treated and RaDC groups (2% and 1%, resp.); grade-3 ORN had not occurred by the time the analysis was conducted. As expected, fewer extractions were performed in the RaDC cohort (no extractions in 47% of the RaDC/IMRT cohort vs. 27% in the IMRT cohort receiving conventional dental care).
  
  
  CONCLUSIONS
  After considerably less invasive dental treatment, no higher-grade ORN occurred and no ORN-related jaw resections were required. Based on the present data, risk-adapted minimally invasive dental care is recommended before IMRT.
authors.affiliation: Clinic for Radiation Oncology, University Hospital Zurich, Zurich, Switzerland. gabriela.studer@usz.ch
authors.forename: Gabriela
authors.initials: G
authors.lastname: Studer
authors.forename: Christoph
authors.initials: C
authors.lastname: Glanzmann
authors.forename: Stephan P
authors.initials: SP
authors.lastname: Studer
authors.forename: Klaus W
authors.initials: KW
authors.lastname: Grätz
authors.forename: Marius
authors.initials: M
authors.lastname: Bredell
authors.forename: Michael
authors.initials: M
authors.lastname: Locher
authors.forename: Urs M
authors.initials: UM
authors.lastname: Lütolf
authors.forename: Roger A
authors.initials: RA
authors.lastname: Zwahlen
mesh_terms: D016371:Cranial Irradiation; D003729:Dental Care / Q000379:methods*; D006801:Humans; D007571:Jaw Diseases / Q000517:prevention & control*; D009062:Mouth Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D010025:Osteoradionecrosis / Q000517:prevention & control*; D011300:Preoperative Care; D050397:Radiotherapy, Intensity-Modulated; D012307:Risk Factors; D014081:Tooth Extraction / Q000706:statistics & numerical data; D014987:Xerostomia / Q000517:prevention & control