Factors associated with oral hygiene compliance in patients treated with radiation therapy for head and neck cancer

Jiwon Lim, Erika S. Helgeson, Rajesh V. Lalla, Thomas P. Sollecito, Nathaniel S. Treister, Brian L. Schmidt, Lauren L. Patton, Alexander Lin, Zvonimir Milas, Michael T. Brennan

Research output: Contribution to journalArticlepeer-review


Background: Patients who are oral hygiene noncompliant (OHNC) are more likely to lose teeth after radiation therapy (RT) for head and neck cancer (HNC), which increases the risk of developing osteoradionecrosis. A previous study revealed that patients who were OHNC at baseline (BL) who became oral hygiene compliant during follow-up had the best tooth-failure outcomes. The purpose of this study was to identify factors associated with oral hygiene compliance (OHC), overall, and among those who were BL OHNC. Methods: This was an observational, prospective, cohort study of 518 patients with HNC assessed before RT and at post-RT follow-up visits every 6 months for 2 years. Patient and treatment-related information was collected at BL and during follow-up, including self-reported OHC. OHC was defined as toothbrushing at least twice daily and flossing at least once daily. Results: Of the 296 patients who self-reported being BL OHNC, 44 (14.9%) became oral hygiene compliant at all follow-up visits. Among this group, those who had dental insurance (P = .026), surgery before RT (P = .008), limited mouth opening before RT (P = .001), compliant fluoride use (P = .023), primary RT site of oral cavity (P = .004), and primary surgical site of larynx and hypopharynx (P = .042) were more likely to become oral hygiene compliant post-RT. Conclusions: The reasons for the cohort of patients with HNC in this study being OHNC are multifaceted and relate to socioeconomic factors and cancer characteristics. Practical Implications: Finding ways to increase OHC and fluoride use among patients with HNC who are at greatest risk of being OHNC should be explored.

Original languageEnglish (US)
Pages (from-to)319-328.e2
JournalJournal of the American Dental Association
Issue number4
StatePublished - Apr 2024


  • Head and neck cancer
  • oral hygiene compliance
  • radiation therapy

ASJC Scopus subject areas

  • General Dentistry


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