Findings suggest dental extractions should not be performed after radiation
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Key takeaways:
- Thirty patients underwent a median 8.5 extractions dental extractions immediately following radiation therapy.
- Thirteen of them developed exposed alveolar bone.
Dental extractions after radiation therapy to the head and neck should not be routinely performed due to considerable risk, according to results of a prospective cohort study.
“If you cannot remove the teeth prior to radiation, then treating without extraction is probably the best approach,” Matthew C. Ward, MD, radiation oncologist in the department of radiation oncology at Levine Cancer Institute at Atrium Health, told Healio. “It may be safe to perform extractions after radiation if the dose to the mandible/oral cavity is sufficiently low.”
Guidelines recommend that nonrestorable teeth be extracted before patients receive radiation therapy to the head and neck. However, pre-radiation extractions can cause treatment delays.
Ward and colleagues evaluated the feasibility and safety of performing dental extractions immediately after radiation therapy.
The prospective cohort study included 50 patients unwilling or unable to have at least one dental extraction prior to radiation therapy to the head and neck.
Study participants received dental care at one academic department, and they received cancer care at regional centers. Researchers recommended dental extractions be performed within 4 months of radiation therapy completion.
Alveolar bone noted by any practitioner following extraction served as the primary endpoint.
Thirty-two (64%) patients had nonoperative radiation therapy and 18 (36%) had postoperative radiation. All patients received intensity-modulated radiotherapy.
Twenty patients declined dental extractions immediately following radiation therapy. The other 30 underwent a median 8.5 extractions (range, 1-28) at a median 64.5 days (range, 13-152) after completion of radiation therapy.
Median follow-up for survivors without exposed bone was 26 months (interquartile range, 17-35) after radiotherapy.
Results showed a 27% (95% CI, 14-40) cumulative incidence of any exposed bone at 2 years, with higher 2-year cumulative incidence of exposed bone among those who underwent dental extractions after radiation than those who did not (40% vs. 7%).
Among the 13 patients who developed exposed bone, eight had confirmed osteoradionecrosis. Four cases resolved and one person had been lost to follow-up.
Researchers acknowledged study limitations, including the small cohort in the single-institution pilot study, lack of long-term follow-up, and the fact patients in the cohort had a variety of primary cancer sites, which may have different rates of osteoradionecrosis.
“If teeth could be safely removed after radiation, it would accelerate time to cancer treatment,” Ward told Healio. “Unfortunately, that seems not to be the case. However, the chance of [osteoradionecrosis] seems low in the first years so, if medically necessary to start cancer treatments quickly, providers should feel comfortable starting without extractions.”
Ward added he would like to see a randomized trial to compare pre-radiation therapy extractions vs. observation.
“It is unclear if extracting at all is helpful,” he said.
For more information:
Matthew C. Ward, MD, can be reached at matthew.ward@atriumhealth.org.
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Ward MC, et al. JAMA Otolaryngol Head Neck Surg. 2024;doi:10.1001/jamaoto.2024.2353.
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