Head and Neck Cancer (HaNC) can be treated with radiotherapy with or without other treatments including surgery and chemotherapy. Mucositis, dry mouth and loss of taste are short-term side effects of radiotherapy; long terms effects include radiation caries, trismus and osteoradionecrosis (ORN). ORN has high morbidity and is challenging and costly to treat. Typically, it is recommended to extract teeth of poor prognosis prior to radiotherapy treatment to preventing the need for extraction post-radiotherapy extraction and potential osteoradionecrosis development. Missing teeth can have a wide range of negative impacts on oral function adversely affecting quality of life. While replacing missing teeth can avoid or minimising the impact of missing teeth some clinicians advise the use of dentures while others do not.
The aim of this review was to assess the evidence of the impact of replacing missing teeth with dentures on the development of osteoradionecrosis in patients who have received radiotherapy for HaNC.
Searches were conducted on the Medline, Embase, PsychoINFO, international Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov databases. All studies in patients age 18 or older who had teeth replaced with dentures treatment of HaNC following radiotherapy were considered. The main outcome was the occurrence of osteoradionecrosis in HaNC patients’ post-radiotherapy. Two reviewers independently screened the studies and extracted data. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. A narrative summary was presented.
- Only 3 retrospective case-control studies involving a total of 273 patients were included.
- The proportion of patients receiving high dose radiation varied from 64-100%.
- None of the included studies can be considered to be a low risk of bias.
The authors concluded: –
Evidence in the currently available literature indicates that ORN may not be associated with denture use especially if well-fitting and not causing sores/irritation. However, very little evidence exists, and the robustness of the studies is questionable. Research using clear methodology to assess the impact of the use of dentures on the development of ORN in HaNC patients post-radiotherapy is warranted. Crucially, well-powered studies, which take into account other radio- therapy-related factors and are clear on definitions of ORN, and the type, timing and use of dentures are needed.
This review has followed a good methodological approach, however only a small number of low-quality studies were identified addressing the key question ‘Does wearing dentures increase the risk of developing osteoradionecrosisin head and neck cancer patients post-radiotherapy? ‘
All 3 of the included studies were case controlled studies so retrospective, but as the authors highlight many of the studies lacked relevant details. For example, none of the studies provided details of how denture use was measured, information on denture materials or denture site. In 2 out of the 3 studies there were also concerns regarding the comparability of the groups. Because of the poor quality studies available the main benefit of this review is to highlight the fact that there is very little evidence of this topic and highlight the need for high quality well conducted and reported studies.
More widely in relation to ORN it is worth noting a recent Cochrane review (Dental Elf – 29th Nov 2019) looking more broadly at interventions for the prevention of ORN only identified 4 RCTs, all at high risk of bias. Also highlighting the need to conduct high quality studies in this area.
Abed H, Burke M, Scambler S, Scott SE. Denture use and osteoradionecrosis following radiotherapy for head and neck cancer: A systematic review. Gerodontology. 2020 Jun;37(2):102-109. doi: 10.1111/ger.12456. Epub 2019 Dec 30. PMID: 31886587.
Abed H, Burke M, Fenlon MR, Scambler S, Scott SE. Denture use and dental risk factors associated developing osteoradionecrosis after head and neck radiotherapy: A retrospective analysis of hospital records. J Dent. 2020 Aug;99:103410. doi: 10.1016/j.jdent.2020.103410. Epub 2020 Jun 20. PMID: 32569711.
Dental Elf – 29th Nov 2019