Research Description:

A Retrospective Study of the Effectiveness of Prophylactic Extractions in Preventing Osteoradionecrosis

Osteoradionecrosis (ORN) is a serious, lifelong, potential complication of head and neck radiation therapy. Osteoradionecrosis can occur when hypocellular, hypovascular, irradiated bone becomes traumatized, particularly after a dental extraction. Numerous cases of ORN have resulted from extraction of carious or periodontally diseased teeth. There have been documented cases of ORN 20-40 years after radiotherapy was delivered to the head and neck region. Treatment of ORN can include lengthy and costly hyperbaric oxygen therapy and, in some cases, debilitating and disfiguring resection of the mandible or maxilla.

A common concern that exists among general dentists is the decision to extract or save teeth that are in the proposed high dose field of head and neck radiation, before radiation therapy is instituted. Pre-radiation therapy extractions can be recommended in order to reduce the future risk of ORN, by eliminating teeth that could become carious or periodontally diseased during the patient’s lifetime. To date, there are no retrospective studies that examine whether the risk of ORN is reduced with prophylactic pre-therapy extractions.

Dental and medical records of patients who are 55 years old or less will be reviewed to document oral post-radiotherapy complications including: caries, progression of periodontal disease and ORN in irradiated areas. The incidence and type of post-radiotherapy complications of the patients will be compared between two groups those having had pre-radiation therapy extractions vs. those having no extractions prior to radiation therapy. This data will be evaluated to attempt to ascertain if pre-radiation therapy prophylactic extractions reduce long-term complications, namely osteoradionecrosis. Information derived from this study could assist the patient and health care provider in these pre-treatment decisions.