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. 2025 Jul 2;25(1):1008.
doi: 10.1186/s12903-025-06391-7.

Frequency of periodontal disease in head and neck cancer patients after radiation therapy: a cross-sectional study

Asmaa Abou-Bakr  1 , Enji Ahmed  2 , Hany William  3 , Fatma E A Hassanein  4
Affiliations

Frequency of periodontal disease in head and neck cancer patients after radiation therapy: a cross-sectional study

Asmaa Abou-Bakr et al. BMC Oral Health. .

Abstract

Background: Patients with head and neck cancer (HNC) receiving radiation therapy (RT) have complications affecting both general and dental health. While RT is effective against HNC, it negatively impacts oral tissues, including changes in periodontal attachment. This study aimed to evaluate the frequency of periodontal disease among HNC patients after RT in a sample of the Egyptian population, as well as to assess the associated risk factors.

Materials and methods: A prospective cross-sectional study was conducted on 189 HNC patients attending a radiation center in Cairo, Egypt. Eligible patients underwent a full periodontal examination including plaque index (PI), bleeding on probing (BOP), clinical attachment level (CAL), and probing pocket depth (PPD). Subsequently, Clinical Oral Dryness Score (CODS), salivary flow rate and body mass index (BMI) were assessed to examine associations with periodontal health.

Results: Periodontal disease was diagnosed in 183 (96.8%) HNC patients. Among them, 174 (95.08%) cases were diagnosed as periodontitis and 9 (4.9%) as gingivitis. The distribution of periodontitis different stages was as follows: Stage I was found in 21 (12.07%) cases, Stage II in 30 (17.24%), Stage III in 55 (31.61%), and Stage IV in 68 (39.08%). The correlation between the number of RT fractions and periodontal disease severity was not statistically significant (p = 0.837). However, there was a strong negative correlation between periodontitis stage and both body mass index (BMI) and salivary flow rate. In contrast, strong positive correlations were observed between periodontitis severity and RT dose, plaque percentage, and Clinical Oral Dryness Score (CODS).

Conclusions: The frequency of periodontitis in the studied sample of HNC patients post RT was 95.08%, reflecting a notably high burden. The most prevalent periodontitis stage was the severe form (Stage IV). Higher periodontitis severity was found to be positively associated with RT dose, plaque percentage, and CODS, suggesting factors to plan future investigation on preventive care in HNC patients. While causality cannot be inferred due to the study design, these findings could be useful in developing more effective clinical management strategies in future research.

Trial registration: The study was retrospectively registered on 29/10/2024 at ClinicalTrials.gov (NCT06667362).

Keywords: Cancer; Egypt; Head and neck cancer; Periodontitis; Radiotherapy; Saliva.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The current study was conducted in compliance with the ethical principles of the Helsinki Declaration for medical research involving human subjects, as revised in 2013, and follows the guidelines applicable to observational, cross-sectional studies. The study protocol was reviewed and approved by the Ahmed Maher Hospital research ethics committee (HAM00212). All eligible individuals provided with written informed consent to participate in the current study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram for HNC patients’ recruitment
Fig. 2
Fig. 2
Box and whisker plots for different correlations with different periodontitis stages
See this image and copyright information in PMC

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