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

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 t...

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Bibliographic Details
Published in:Supportive care in cancer 2022-11, Vol.30 (11), p.8745-8759
Main Authors: Normando, Ana Gabriela Costa, Pérez-de-Oliveira, Maria Eduarda, Guerra, Eliete Neves Silva, Lopes, Márcio Ajudarte, Rocha, André Caroli, Brandão, Thaís Bianca, Prado-Ribeiro, Ana Carolina, Gueiros, Luiz Alcino Monteiro, Epstein, Joel B., Migliorati, César Augusto, Santos-Silva, Alan Roger
Format: Article
Language:English
Subjects:
Comparative analysis
Cross-Sectional Studies
Dental surgery
Head & neck cancer
Head and Neck Neoplasms - complications
Head and Neck Neoplasms - radiotherapy
Health risks
Humans
Medicine
Medicine & Public Health
Meta-analysis
Nursing
Nursing Research
Oncology
Osteoradionecrosis - etiology
Osteoradionecrosis - prevention & control
Pain Medicine
Radiation therapy
Radiotherapy
Rehabilitation Medicine
Review Article
Systematic review
Tooth Extraction
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Summary: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.
ISSN:0941-4355
1433-7339
DOI:10.1007/s00520-022-07215-y