TY - JOUR
T1 - Tooth Failure Post-Radiotherapy in Head and Neck Cancer
T2 - Primary Report of the Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad) Study
AU - Brennan, Michael T.
AU - Treister, Nathaniel S.
AU - Sollecito, Thomas P.
AU - Schmidt, Brian L.
AU - Patton, Lauren L.
AU - Lin, Alexander
AU - Elting, Linda S.
AU - Hodges, James S.
AU - Lalla, Rajesh V.
N1 - Funding Information:
This study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad), was funded by the National Institute of Dental and Craniofacial Research (NIDCR), National Institutes of Health (NIH), United States (1U01DE022939-01).
Funding Information:
Development of post-RT dental caries in HNC patients increases the risk of dental extraction, which in turn increases the risk of ORN. 5 Pre-RT dental assessment and treatment are considered best practice and standard of care for HNC patients, but these practices vary widely due to lack of clear data on dental morbidity in this patient population. 6 To address gaps in our knowledge of dental/oral outcomes and dental management strategies, a multicenter, prospective study of HNC patients receiving curative-intent RT (Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients [OraRad]) was initiated and funded by the US National Institute of Dental and Craniofacial Research. 7 The main outcomes included tooth failure, exposed bone/ORN and changes in dental caries, periodontal disease, and stimulated whole salivary flow during the 2-year follow-up; a study aim was assessing risk factors for these outcomes. The present article reports on the rate of and risk factors for tooth failure, and the other main outcomes are being reported separately.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Purpose: To elucidate long-term sequelae of radiation therapy (RT) in head and neck cancer (HNC) patients, a multicenter, prospective study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad), was established with tooth failure as its primary outcome. We report tooth failure and associated risk factors. Methods and Materials: Demographics and cancer and dental disease characteristics were documented in 572 HNC patients at baseline and 6, 12, 18, and 24 months after RT. Eligible patients were aged 18 or older, diagnosed with HNC, and receiving RT to treat HNC. Tooth failure during follow-up was defined as losing a tooth or having a tooth deemed hopeless. Analyses of time to first tooth-failure event and number of teeth that failed used Kaplan-Meier estimators, Cox regression, and generalized linear models. Results: At 2 years, the estimated fraction of tooth failure was 17.8% (95% confidence interval, 14.3%-21.3%). The number of teeth that failed was higher for those with fewer teeth at baseline (P < .0001), greater reduction in salivary flow rate (P = .013), and noncompliance with daily oral hygiene (P = .03). Patients with dental caries at baseline had a higher risk of tooth failure with decreased salivary flow. Patients who were oral-hygiene noncompliant at baseline but compliant at all follow-up visits had the fewest teeth that failed; greatest tooth failure occurred in participants who were noncompliant at baseline and follow-up. Conclusions: Despite pre-RT dental management, substantial tooth failure occurs within 2 years after RT for HNC. Identified factors may help to predict or reduce risk of post-RT tooth failure.
AB - Purpose: To elucidate long-term sequelae of radiation therapy (RT) in head and neck cancer (HNC) patients, a multicenter, prospective study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad), was established with tooth failure as its primary outcome. We report tooth failure and associated risk factors. Methods and Materials: Demographics and cancer and dental disease characteristics were documented in 572 HNC patients at baseline and 6, 12, 18, and 24 months after RT. Eligible patients were aged 18 or older, diagnosed with HNC, and receiving RT to treat HNC. Tooth failure during follow-up was defined as losing a tooth or having a tooth deemed hopeless. Analyses of time to first tooth-failure event and number of teeth that failed used Kaplan-Meier estimators, Cox regression, and generalized linear models. Results: At 2 years, the estimated fraction of tooth failure was 17.8% (95% confidence interval, 14.3%-21.3%). The number of teeth that failed was higher for those with fewer teeth at baseline (P < .0001), greater reduction in salivary flow rate (P = .013), and noncompliance with daily oral hygiene (P = .03). Patients with dental caries at baseline had a higher risk of tooth failure with decreased salivary flow. Patients who were oral-hygiene noncompliant at baseline but compliant at all follow-up visits had the fewest teeth that failed; greatest tooth failure occurred in participants who were noncompliant at baseline and follow-up. Conclusions: Despite pre-RT dental management, substantial tooth failure occurs within 2 years after RT for HNC. Identified factors may help to predict or reduce risk of post-RT tooth failure.
KW - Dental Caries/epidemiology
KW - Head and Neck Neoplasms/radiotherapy
KW - Humans
KW - Prospective Studies
KW - Registries
KW - Risk Factors
UR - http://www.scopus.com/inward/record.url?scp=85123722367&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85123722367&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2021.11.021
DO - 10.1016/j.ijrobp.2021.11.021
M3 - Article
C2 - 34879248
AN - SCOPUS:85123722367
SN - 0360-3016
VL - 113
SP - 320
EP - 330
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 2
ER -