Published Article

Effect of preradiation dental intervention on incidence of osteoradionecrosis in patients with head and neck cancer: A systematic review and meta-analysis

Original Publisher or Platform

Journal of the American Dental Association

Original Article Link

https://doi.org/10.1016/j.adaj.2022.06.003

Publication Date

10-2022

Abstract

This search strategy was constructed to support the research for the peer reviewed article listed above. Full article abstract:

Background

The purpose of this systematic review was to examine whether dental intervention involving bone or soft-tissue manipulation preradiotherapy (pre-RT) is associated with lower rates of osteoradionecrosis of the jaw (ORNJ) in patients with head and neck cancer (HNC).

Types of Studies Reviewed

The authors included relevant studies from MEDLINE, Embase, and Cochrane Library, including observational studies published from 2007 through 2021 and involving adults who underwent dental intervention pre-RT for HNC. Authors assessed evidence certainty by using the Grading of Recommendations Assessment, Development, and Evaluation approach. Random-effects models were used to calculate pooled relative risk estimates and hazard ratios. When meta-analysis was not possible, study-level measures of association and narrative summaries of the evidence were reported.

Results

Twenty-two studies were included. From the pooled, unadjusted analysis, patients undergoing pre-RT extractions may have a 55% increased risk of experiencing ORNJ (relative risk, 1.55; 95% CI, 0.85 to 2.86; very low certainty); the unadjusted pooled hazard ratio was 3.19 (95% CI, 0.99 to 10.31; very low certainty), corresponding to a possible increased hazard of developing ORNJ (very low certainty). Findings for other pre-RT procedures manipulating bone or tissue relied on limited, observational studies with low or very low certainty evidence.

Conclusions

Mostly very low certainty evidence suggests that patients with HNC who need pre-RT dental intervention may have an increased risk of developing ORNJ compared with those who do not. Practical Implications. Maintaining optimal oral health may help reduce the need for urgent pre-RT dental treatment, potentially reducing ORNJ risk and minimizing delay of oncologic treatment in patients with HNC.

PICO(T) or Research Question

Is dental intervention involving bone or soft-tissue manipulation preradiotherapy (pre-RT) associated with lower rates of osteoradionecrosis of the jaw (ORNJ) in patients with head and neck cancer (HNC)?

Search Type

Meta-Analyses, Systematic Review

Databases included

PubMed or PubMed subsidiary, Embase, Cochrane

Acknowledgments

Funding for the research described in this article was provided in full by the American Dental Association. The full article was authored by:

Olivia Urquhart, MPH; Hillary R. DeLong, JD; Kathleen M. Ziegler, PharmD; Lauren Pilcher, MSPH; Sarah Pahlke, MS; Malavika P. Tampi, MPH; Kelly K. O’Brien, MLIS; Lauren L. Patton, DDS; Nishant Agrawal, MD, FACS; Theresa M. Hofstede, BSc, DDS, FACP; Deepak Kademani, DMD, MD, FACS; Mark W. Lingen, DDS, PhD, FRCPath; Nathaniel S. Treister, DMD, DMSc; C. Jillian Tsai, MD, PhD; Alonso Carrasco-Labra, DDS, MSc, PhD; Ruth D. Lipman, PhD

This review was done in response to the American Dental Association House of Delegates resolution 86H-2016, which directed the American Dental Association to address optimizing dental health before specific surgical or medical procedures and treatment.

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