title: Antibiotic protocol for the prevention of osteoradionecrosis following dental extractions in irradiated head and neck cancer patients: A 10 years prospective study.
abstract: OBJECTIVE
  The aim of the study was to establish the long term efficacy of a perioperative antibiotic protocol combined with antibacterial mouthwashes in preventing osteoradionecrosis (ORN).
  
  
  METHODS
  Irradiated head and neck cancer patients reporting for dental extractions were prospectively enrolled to the study between January 2002 and December 2009. Selection criteria for the patients included the presence of nonrestorable tooth/teeth in the field of radiation, latency period of 6 months since completion of radiotherapy, radiation dosages >60 Gy, and availability for follow-up. Starting from 10 days preextraction, the patients were prescribed 8th hourly oral amoxicillin 500 mg along with 12th hourly mouthwashes using 10 ml of undiluted chlorhexidine gluconate 0.2% solution. The same prescription was continued for 7 days postextraction. All patients were followed-up at regular intervals until December 2013.
  
  
  RESULTS
  A total of 89 patients (55 male and 34 female) underwent extractions of teeth which were present in the radiation field. Mean age of the patients was 41.8 years (range 36-54 years) and extractions were done between 12 and 33 months (mean - 15 months) postradiation therapy. Altogether, 232 teeth were extracted (maxilla - 78/mandible - 154) at an average of 2.6 teeth per patients. After a mean follow-up period of 63 months (range 48-123 months) there were no reported cases of ORN.
  
  
  CONCLUSIONS
  Based on the results of this study, perioperative oral antibiotics in combination with antibacterial mouthwashes are effective in preventing ORN following dental extractions in irradiated patients.
authors.affiliation: Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Saleh A
authors.initials: SA
authors.lastname: Al-Bazie
authors.affiliation: King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Mesaad
authors.initials: M
authors.lastname: Bahatheq
authors.affiliation: King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Al-Ghazi
authors.affiliation: King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Nasser
authors.initials: N
authors.lastname: Al-Rajhi
authors.affiliation: Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Sundar
authors.initials: S
authors.lastname: Ramalingam
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes; D010025:Osteoradionecrosis / Q000517:prevention & control*; D011446:Prospective Studies; D014081:Tooth Extraction / Q000009:adverse effects*
chemical_list: D009067:Mouthwashes