Sage Journals: Discover world-class research

Abstract

Background:

Treatment for head and neck cancer (HNC) such as radiotherapy (RT) can lead to numerous acute and chronic head and neck sequelae, including dental caries. The goal of the present study was to measure 2-y changes in dental caries after radiotherapy in patients with HNC and test risk factors for caries increment.

Methods:

Cancer and dental disease characteristics, demographics, and oral health practices were documented before and 6, 12, 18, and 24 mo after the start of RT for 572 adult patients with HNC. Patients were eligible if they were age 18 y or older, diagnosed with HNC, and planned to receive RT for treatment of HNC. Caries prevalence was measured as decayed, missing, and filled surfaces (DMFS). The association between change in DMFS and risk factors was evaluated using linear mixed models.

Results:

On average, DMFS increased from baseline to each follow-up visit: 6 mo, +1.11; 12 mo, +2.47; 18 mo, +3.43; and 24 mo, +4.29 (P < 0.0001). The increase in DMFS during follow-up was significantly smaller for the following patient characteristics: compliant with daily fluoride use (P = 0.0004) and daily oral hygiene (brushing twice daily and flossing daily; P = 0.015), dental insurance (P = 0.004), and greater than high school education (P = 0.001). DMFS change was not significantly associated with average or maximum RT dose to the parotids (P > 0.6) or salivary flow (P > 0.1). In the subset of patients who had salivary hypofunction at baseline (n = 164), lower salivary flow at follow-up visits was associated with increased DMFS.

Conclusion:

Increased caries is a complication soon after RT in HNC. Fluoride, oral hygiene, dental insurance, and education level had the strongest association with caries increment after radiotherapy to the head and neck region. Thus, intensive oral hygiene measures, including fluoride and greater accessibility of dental care, may contribute to reducing the caries burden after RT in HNC.

Knowledge Transfer Statement:

The results of this study can be used by clinicians when deciding how to minimize oral complications related to cancer therapy for patients with head and neck cancer. Identification of modifiable factors (e.g., oral hygiene and prescription fluoride compliance) associated with increased caries risk can minimize radiation caries burden.

Keywords

head and neck neoplasms cohort study risk factors patient compliance fluoride dental caries

Get full access to this article

View all access options for this article.

References

Adrien

Bertolus

Gambotti

Mallet

Baujat

. 2014. Why are head and neck squamous cell carcinoma diagnosed so late? Influence of health care disparities and socio-economic factors. Oral Oncol. 50(2):90–97.

American Cancer Society. 2017. Cancer facts & figures 2017. Atlanta (GA): American Cancer Society.

Bates

Mächler

Bolker

Walker

. 2015. Fitting linear mixed-effects models using lme4. J Stat Softw. 67(1):1–48.

Bhandari

Soni

Ghoshal

. 2021. Impact of non-compliance with oral care on radiation caries in head and neck cancer survivors. Support Care Cancer. 29(8):4783–4790.

Brennan

Treister

Sollecito

Schmidt

Patton

Yang

Lin

Elting

Hodges

Lalla

. 2021. Epidemiologic factors in patients with advanced head and neck cancer treated with radiation therapy. Head Neck. 43(1):164–172.

Choi

Terrell

Fowler

McLean

Ghanem

Wolf

Bradford

Taylor

Duffy

. 2016. Socioeconomic and other demographic disparities predicting survival among head and neck cancer patients. PLoS One. 11(3):e0149886.

Dawes

Pedersen

Villa

Ekstrom

Proctor

Vissink

Aframian

McGowan

Aliko

Narayana

, et al. 2015. The functions of human saliva: a review sponsored by the World Workshop on Oral Medicine VI. Arch Oral Biol. 60(6):863–874.

Deasy

Moiseenko

Marks

Chao

Nam

Eisbruch

. 2010. Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys.76(3 Suppl):S58–S63.

Deng

Jackson

Epstein

Migliorati

Murphy

. 2015. Dental demineralization and caries in patients with head and neck cancer. Oral Oncol. 51(9):824–831.

10.

Epstein

van der Meij

Emerton

Stevenson-Moore

. 1995. Compliance with fluoride gel use in irradiated patients. Spec Care Dentist. 15(6):218–222.

11.

Hong

Napenas

Hodgson

Stokman

Mathers-Stauffers

Elting

Spijkervet

Brennan

, Dental Disease Section OCSG, Multi-national Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO). 2010. A systematic review of dental disease in patients undergoing cancer therapy. Oral Care Study Group, Multi-National Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO). Support Care Cancer. 18(8):1007–1021.

12.

Kerr

. 2003. Decision-making for preradiation dental extractions is based primarily on experience and opinion. Evid Based Dent. 4(1):11.

13.

Kielbassa

Hinkelbein

Hellwig

Meyer-Luckel

. 2006. Radiation-related damage to dentition. Lancet Oncol. 7(4):326–335.

14.

Kuznetsova

Brockhoff

Christensen

. 2017. Lmertest package: tests in linear mixed effects models. J Stat Softw. 82(13):1–26.

15.

Lalla

Brennan

Schubert

. 2010. Oral complications of cancer therapy. In: Yagiela

Dowd

Johnson

Mariotti

Neidle

, editors. Pharmacology and therapeutics for dentistry. 6th ed. St. Louis (MO): Mosby/Elsevier.

16.

Lalla

Long-Simpson

Hodges

Treister

Sollecito

Schmidt

Patton

Brennan

. 2017. Clinical registry of dental outcomes in head and neck cancer patients (OraRad): rationale, methods, and recruitment considerations. BMC Oral Health. 17(1):59.

17.

Lenth

. 2020. Emmeans: Estimated Marginal Means, aka Least-Squares Means. R package version 1.4.6. https://CRAN.R-project.org/package=emmeans

18.

Moore

McLister

Cardwell

O’Neill

Donnelly

McKenna

. 2020. Dental caries following radiotherapy for head and neck cancer: a systematic review. Oral Oncol. 100:104484.

19.

R Core Team. 2019. A language and environment for statistical computing. Vienna (Austria): R Foundation for Statistical Computing; [accessed October 29, 2019]. http://www.R-project.org/.

20.

Reuther

Schuster

Mende

Kubler

. 2003. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients—a report of a thirty year retrospective review. Int J Oral Maxillofac Surg. 32(3):289–295.

21.

Schwendicke

Dorfer

Schlattmann

Foster Page

Thomson

Paris

. 2015. Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res. 94(1):10–18.

22.

Siala

Mnejja

Elloumi

Ghorbel

Mnif

Frikha

Daoud

. 2014. Late toxicities after conventional radiotherapy for nasopharyngeal carcinoma: incidence and risk factors. J Radiother. 2014:268340.

23.

Thariat

Ramus

Darcourt

Marcy

Guevara

Odin

Poissonnet

Castillo

Ali

Righini

. 2012. Compliance with fluoride custom trays in irradiated head and neck cancer patients. Support Care Cancer. 20(8):1811–1814.

24.

Vissink

Jansma

Spijkervet

Burlage

Coppes

. 2003. Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med. 14(3):199–212.

25.

Walker

Wichman

Cheng

Coster

Williams

. 2011. Impact of radiotherapy dose on dentition breakdown in head and neck cancer patients. Pract Radiat Oncol. 1(3):142–148.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.10 MB

Dental Caries Postradiotherapy in Head and Neck Cancer

Abstract

Background:

Methods:

Results:

Conclusion:

Knowledge Transfer Statement:

Keywords

Get full access to this article

References

Supplementary Material