Denture use and osteoradionecrosis following radiotherapy for head and neck cancer: A systematic review

Abed, H., Burke, M., Scambler, S., Scott, S. E. (2019). PubMed.

Terms within the article:

• Radiotherapy: Also known as radiation therapy, it is a cancer treatment that uses high-energy radiation to kill malignant cells and control their spread. 
• Osteoradionecrosis (ORN): Bone death due to damage caused to the blood vessels from radiation. 

 
What is this research about?:

• This systematic review investigates whether wearing dentures post-radiotherapy increases the risk of developing osteoradionecrosis in head & neck cancer (HaNC) patients.
• While it is strongly recommended that HaNC patients who are considering radiotherapy have their teeth with poor prognosis extracted pre-treatment, dental extraction has been proven to lead to significant negative impacts such as difficulty with and lack of interest in eating, problems with oral function, decreased communication, and poorer quality of life. 
• Replacing teeth with dentures can help to avoid or minimise these side effects, but there is debate among clinicians over whether or not using dentures post-radiotherapy can increase risk of developing ORN. 

 
Methods/Methodology:

• Three retrospective case-control studies with a total sample size of 49-149 participants were included in the review. 
• The common aim of the three studies was to identify if wearing dentures post-radiotherapy is a risk factor for the development of ORN in HaNC patients rather than directly assessing the effect of dentures on ORN. 
• Data for this review came from information on the participants, length of follow-up, site of cancer, volume and type of radiotherapy, denture details, and development of ORN that was extracted from each paper, when available. 
• However, details of data collection and documentation varied between the studies. 

 
Results:

• Evidence from current literature suggests that dentures may not cause/increase risk for ORN, especially if they are well-fitted and do not cause sores or irritation. 
• However, very little evidence for this exists and the condition of the studies is questionable. 
• For instance, none of the studies described how they assessed denture use in a standard, validated, or reliable way, and important factors such as when the patients had their teeth extracted, what type of radiotherapy was administered, and the mode and field of radiation were either not reported, not considered, or varied greatly. 

 
Discussion:

• These findings would be of interest to individuals, e.g. clinicians, patients, students, considering radiotherapy, and/or want to learn more about possible effects of denture use post teeth extraction and radiotherapy 
• Although more robust, further research is necessary, clinicians and patients should be mindful of the results of these studies when recommending or considering denture use post-radiotherapy. 

 
Possible questions to ask your doctor:

• How would denture use affect my everyday life?
• If I were to develop ORN, how would it affect my everyday life? What is the treatment for it?
• What are some possible negative side effects of getting my teeth extracted?
• (Aside from ill-fitting dentures) What factors increase my likelihood of developing ORN and can I prevent or minimize them?
• How can I ensure that my dentures will fit well and will not cause irritation/sores?
• Will I be seen for follow-up appointments to check for ORN post-radiotherapy? For how long?
• What is the process for determining which, if any, teeth should be extracted?
• If I don’t want dentures, are there other options (e.g. implants)?

 

Reference: Abed, H., Burke, M., Scambler, S., & Scott, S. E. (2019). Denture use and osteoradionecrosis following radiotherapy for head and neck cancer: A systematic review. Gerodontology. doi:10.1111/ger.12456 

Summary written by Avery Singson; Edited by Wendy Liang
September 21, 2020