The effect of dental and salivary gland radiation dose on the occurrence of post-radiotherapy dental disease in patients with head and neck cancer

Moreover, meta regression analyses indicated that an increased incidence of post-radiotherapy dental caries may be associated with increased radiotherapy dose, and chemotherapy treatment in addition to radiotherapy.<br><br>A prospective cohort study of 151 HANC patients assessed at baseline (pre-radiotherapy), rendered dentally fit, and followed up at 6-months and 12-months post-radiotherapy, demonstrated that increased mean and maximum dental radiation doses at the dental-sextant level were both associated with an increased odds of post-radiotherapy dental caries after adjusting for potential confounding variables.

The radiation dose exposures of the parotid glands, however, were found to have no impact on the incidence of post-radiotherapy dental caries or post-radiotherapy periodontitis. In addition, the continued consumption of dietary nutritional supplements and patients’ non-compliance with clinical oral hygiene and dietary advice for the prevention of post-radiotherapy dental disease, were also found to be associated with an increased incidence and severity of post-radiotherapy dental caries. <br><br>A separate qualitative investigation of a subgroup of participants (n=12) recruited to the prospective cohort study was also conducted, and determined that patients’ non-compliance with dietary sugar restriction and the use of high fluoride toothpaste may be related to issues regarding communication, inadequate supplies of preventive oral hygiene products, and treatment-related oral discomfort (e.g. oral mucositis).<br><br>Furthermore, a health economics study of costs associated with the management of pre- and post-radiotherapy dental disease was also completed – the first of its kind in the United Kingdom (UK) – and found that HANC patients experience two-three times greater personal dental treatment costs compared to patients from the general population.

In addition, the micro-costings analysis also determined substantial healthcare service costs associated with the management of pre- and post-radiotherapy dental disease.<br><br>Finally, a three-round Delphi survey of 24 Consultants in Restorative Dentistry generated 89 consensus statements concerning the types of teeth that should be extracted prior to radiotherapy. The results of this Delphi study represent the majority view of Consultants in Restorative Dentistry in the UK and Ireland, and it is anticipated that they will be used to inform the development of national and international guidelines regarding the dental management of HANC patients. <br>