Tooth extraction within 2 weeks before radiotherapy and osteoradionecrosis: A nationwide cohort study

Objectives The theory of at least 2-week waiting period between tooth extraction and head and neck radiotherapy could reduce osteoradionecrosis remains controversial. Thus, this study examined the theory and associated factors. Materials and Methods Data were retrieved from the National Health Insurance Research Database, Taiwan Cancer Registry Database, and Cause of Death Statistics. We included 24,353 patients with head and neck cancer who received radiotherapy from 2011 to 2017 and were followed up until 2019. The patients were divided into three groups: those undergoing tooth removal 2-8 weeks before radiotherapy, those undergoing tooth removal within 2 weeks before radiotherapy, and others. Confounding factors were clinical information, physical conditions, and risky habits. We used the Cox regression model to assess osteoradionecrosis risk. Results No significant difference in osteoradionecrosis risk was observed between those undergoing tooth extraction within 2 weeks before radiotherapy and the other groups. An irradiation dose of >= 60 Gy, chemotherapy, tumor excision, post-radiotherapy tooth extraction, mandibulectomy, hyperlipidemia, and oral cavity as the tumor subsite were significantly positively associated with osteoradionecrosis risk. Conclusion A waiting period of >= 2 weeks between tooth extraction and radiotherapy did not significantly reduce osteoradionecrosis risk.

Automated summary

This study examined the effect of a waiting period between tooth extraction and head and neck radiotherapy on osteoradionecrosis risk. The results showed no significant difference in risk between tooth extraction within 2 weeks before radiotherapy and other time periods. Factors such as radiation dose, chemotherapy, tumor excision, post-radiotherapy tooth extraction, mandibulectomy, hyperlipidemia, and oral cavity as tumor subsite were significantly associated with osteoradionecrosis risk.