The relevance of dental management prior to radiation therapy with severe oral mucositis in head and neck cancer patients

Abstract

Background/purpose: Dental management prior to radiotherapy is often time-critical, and there are no studies on whether manipulations such as tooth extraction influence the risk of severe radiation-induced oral mucositis (ROM) during radiotherapy. Therefore, the aim of this study was to describe the relationship between dental management and the incidence of severe ROM.

Materials and methods: A retrospective analysis was conducted on 144 head and neck cancer (HNC) patients who received dental management before radiotherapy at Peking University Cancer Hospital, from January 2016 to December 2017. Demographic characteristics, primary tumor features, cancer treatment characteristics, and severity of oral mucositis during radiotherapy were recorded. Univariate analysis and logistic regression analysis were used to explore factors associated with severe radiation-induced oral mucositis.

Results: The incidence of grade 3 mucositis was 14.5% (22/144); univariate analysis showed that the number of extracted teeth (OR = 1.313; 95%CI = 1.012-1.702; P = 0.040) and patients with primary oral cancer had a higher risk of developing grade 3 mucositis (OR = 3.848; 95% CI = 1.508-9.822; P = 0.005). No statistical correlation was found between pre-radiation therapy prophylaxis, dental restoration, endodontic treatment, and grade 3 mucositis (P > 0.05). Logistic regression analysis showed that the number of extracted teeth (OR = 1.421, 95%CI = 1.071-1.885, P = 0.015) and primary tumor location in the oral cavity (compared with other head and neck cancers) (OR = 5.165, 95%CI = 1.636-16.311, P = 0.005) were significantly associated with grade 3 mucositis.

Conclusion: In HNC patients undergoing radiotherapy, the primary site located in the oral cavity and a higher number of teeth extracted are independent risk factors for the development of severe mucositis.

Keywords: Dental management prior to radiation therapy; Head and neck cancer; Radiation-induced oral mucositis; Retrospective study; Risk factors.

Figure 1

Grade 1 oral mucositis. Mild ulcer covered by yellow fibrin pseudomembrane, affecting buccal membrane after 12 times radiotherapy for nasopharyngeal carcinoma.

Figure 2

Grade 2 oral mucositis. Large ulcer, modified diet indicated but maintaining oral intake without the necessity for analgesics, after 15 times radiotherapy for oral carcinoma.

Figure 3

Grade 3 oral mucositis. Extensive ulcer, crusting, and exudate on the lips and oral mucosa, accompanied by limited mouth opening and oral intake impairment, requiring analgesics after 23 times radiotherapy for oral carcinoma.