To extract or not extract teeth prior to head and neck radiotherapy? A systematic review and meta-analysis

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Normando, Ana Gabriela Costa ; Perez-de-Oliveira, Maria Eduarda ; Silva Guerra, Eliete Neves ; Lopes, Marcio Ajudarte ; Rocha, Andre Caroli ; Brandao, Thais Bianca ; Prado-Ribeiro, Ana Carolina ; Monteiro Gueiros, Luiz Alcino ; Epstein, Joel B. ; Migliorati, Cesar Augusto ; Santos-Silva, Alan Roger ; Oral Care Study Grp ; Multinatl Assoc Supportive Care Ca ; Int Soc Oral Oncology ISOO

• Document type: Journal article
• Source: SUPPORTIVE CARE IN CANCER; v. N/A, p. 15-pg., 2022-06-17.

Abstract

Purpose Teeth with poor prognosis are generally recommended to be extracted prior to head and neck radiotherapy (RT) to reduce the risk of developing osteoradionecrosis (ORN), although controversies have been reported. The present systematic review aimed to determine whether tooth extraction prior to head and neck RT may be associated with a reduced risk of developing ORN compared to dental extraction during or after RT. Methods The review protocol was registered in PROSPERO (CRD42021241631). The review was reported according to the PRISMA checklist and involved a comprehensive search of PubMed, Scopus, Embase, Cochrane Library, LILACS, and Web of Science, in addition to the gray literature. The selection of studies was performed in two phases by two reviewers independently. The risk of bias of individual studies was analyzed using the Joanna Briggs Institute checklist for cross-sectional studies, and the certainty of evidence was assessed using the GRADE tool. Results Twenty-eight observational studies were included in the qualitative synthesis, which showed substantial heterogeneity regarding the association between the timing of tooth extraction and ORN development. Twenty-seven of 28 studies were pooled in a meta-analysis that demonstrated a significant association between an increased risk of ORN and post-RT tooth extraction (odds ratio: 1.98; 95% CI: 1.17-3.35; p = 0.01). Conclusion It was confirmed with moderate certainty that dental extractions should be performed prior to the start of head and neck RT to reduce the risk of ORN. (AU)

• FAPESP's process: 19/09692-9 - Validation of target proteins associated with the progression of potentially malignant disorders into Oral Cancer
• Grantee: Ana Gabriela Costa Normando
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 19/26676-7 - Uncovering the role of CRTC1-MAML2 translocation in salivary Mucoepidermoid Carcinoma: a clinicopathological, molecular and proteomic study
• Grantee: Maria Eduarda Pérez de Oliveira
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 18/02233-6 - Oncological safety of the use of intraoral and extraoral photobiomodulation in patients with oral cavity and oropharyngeal squamous cell carcinoma
• Grantee: Alan Roger dos Santos Silva
• Support Opportunities: Regular Research Grants