Head and neck radiotherapy worsens long-term oral health despite structured dental follow-up

KEY POINTS

• This prospective observational cohort included 113 patients with head and neck cancer who underwent dental assessment and elimination of oral infection foci before RT, followed by structured dental surveillance. Median follow-up was 44.77 months, and the mean tumor dose was 67.65 Gy, delivered with VMAT.
• Among the 49 patients with good oral health at baseline, 17 (34.7%) developed poor oral health during follow-up. Smoking was independently associated with deterioration, with an OR of 4.7 (95% CI 1.27-17.37; p=0.02).
• Caries experience worsened substantially: mean DMFt increased from 15.53 to 19.61, a mean increase of 4.08 points (95% CI 1.60-6.56; p=0.001). Smoking was the only significant predictor of increasing DMFt (β=2.05; p=0.02).
• Periodontal deterioration was more localized than generalized. Sites with probing pocket depth ≥5 mm increased from 4.20 to 7.48 per patient, a difference of 3.28 sites (95% CI 0.52-6.05; p=0.02), while mean probing depth and progression to severe periodontitis were not statistically significant.
• 49 of 113 patients (43.4%) lost at least one tooth. Overall, 239 of 2,513 teeth (9.51%) were extracted, corresponding to a mean loss of 2.12 teeth per patient; caries accounted for 48.5% of extractions and periodontitis for 48.1%.
• Independent predictors of tooth loss were increasing age (OR 1.042 per year, 95% CI 1.005-1.081; p=0.025) and a maximum dose >60 Gy to the prospectively contoured buccal mucosa OAR (OR 2.749, 95% CI 1.148-6.585; p=0.023).
• During follow-up, 43 patients developed hyposalivation and 16 developed trismus, but neither was significantly associated with worsening oral health. Interpretation of the dose signal is limited by substantial dropout, only 17 primary endpoint events, absence of a non-irradiated control group, and use of buccal mucosa dose as a surrogate for dental and periodontal exposure.

CLINICAL TAKEAWAY

SOURCE

Cancers