PDF(Pubmed)
Abstract：
The objective of this study was to identify tooth-level risk factors for use during preradiation dental care management to predict risk of tooth failure (tooth lost or declared hopeless) and exposed bone after radiation therapy (RT) for head and neck cancer (HNC).
The authors conducted a prospective observational multicenter cohort study of 572 patients receiving RT for HNC. Participants were examined by calibrated examiners before RT and then every 6 months until 2 years after RT. Analyses considered time to tooth failure and chance of exposed bone at a tooth location.
The following pre-RT characteristics predicted tooth failure within 2 years after RT: hopeless teeth not extracted pre-RT (hazard ratio [HR], 17.1; P < .0001), untreated caries (HR, 5.0; P < .0001), periodontal pocket 6 mm or greater (HR, 3.4; P = .001) or equaling 5 mm (HR, 2.2; P = .006), recession over 2 mm (HR, 2.8; P = .002), furcation score of 2 (HR, 3.3; P = .003), and any mobility (HR, 2.2; P = .008). The following pre-RT characteristics predicted occurrence of exposed bone at a tooth location: hopeless teeth not extracted before RT (risk ratio [RR], 18.7; P = .0002) and pocket depth 6 mm or greater (RR, 5.4; P = .003) or equaling 5 mm (RR, 4.7; P = .016). Participants with exposed bone at the site of a pre-RT dental extraction averaged 19.6 days between extraction and start of RT compared with 26.2 days for participants without exposed bone (P = .21).
Individual teeth with the risk factors identified in this study should be considered for extraction before RT for HNC, with adequate healing time before start of RT.
The findings of this trial will facilitate evidence-based dental management of the care of patients receiving RT for HNC. This clinical trial was registered at Clinicaltrials.gov. The registration number is NCT02057510.
The authors conducted a prospective observational multicenter cohort study of 572 patients receiving RT for HNC. Participants were examined by calibrated examiners before RT and then every 6 months until 2 years after RT. Analyses considered time to tooth failure and chance of exposed bone at a tooth location.
The following pre-RT characteristics predicted tooth failure within 2 years after RT: hopeless teeth not extracted pre-RT (hazard ratio [HR], 17.1; P < .0001), untreated caries (HR, 5.0; P < .0001), periodontal pocket 6 mm or greater (HR, 3.4; P = .001) or equaling 5 mm (HR, 2.2; P = .006), recession over 2 mm (HR, 2.8; P = .002), furcation score of 2 (HR, 3.3; P = .003), and any mobility (HR, 2.2; P = .008). The following pre-RT characteristics predicted occurrence of exposed bone at a tooth location: hopeless teeth not extracted before RT (risk ratio [RR], 18.7; P = .0002) and pocket depth 6 mm or greater (RR, 5.4; P = .003) or equaling 5 mm (RR, 4.7; P = .016). Participants with exposed bone at the site of a pre-RT dental extraction averaged 19.6 days between extraction and start of RT compared with 26.2 days for participants without exposed bone (P = .21).
Individual teeth with the risk factors identified in this study should be considered for extraction before RT for HNC, with adequate healing time before start of RT.
The findings of this trial will facilitate evidence-based dental management of the care of patients receiving RT for HNC. This clinical trial was registered at Clinicaltrials.gov. The registration number is NCT02057510.
摘要：
背景：这项研究的目的是确定在放射前牙科护理管理期间使用的牙齿水平风险因素，以预测头颈部癌症（HNC）放射治疗（RT）后牙齿衰竭（牙齿脱落或宣布绝望）和暴露骨的风险。
方法：作者对572例接受RT治疗的HNC患者进行了一项前瞻性观察多中心队列研究。参与者在RT之前由校准的检查员检查，然后每6个月检查一次，直到RT后2年。分析了牙齿衰竭的时间和牙齿位置暴露骨的机会。
结果：以下RT前特征预测了RT后2年内的牙齿衰竭：未在RT前拔除的无望牙齿（危险比[HR]，17.1;P<.0001),未经处理的龋齿（HR，5.0;P<.0001),牙周袋6毫米或更大(HR，3.4；P=.001）或等于5mm（HR，2.2；P=.006)，衰退超过2毫米(HR，2.8；P=.002），分叉评分为2(HR，3.3；P=.003)，和任何流动性(HR，2.2；P=.008）。以下RT前特征预测了牙齿位置暴露骨的发生：在RT前没有拔除的无望牙齿（风险比[RR]，18.7;P=.0002)和凹槽深度6mm或更大(RR,5.4；P=.003）或等于5mm（RR，4.7；P=.016）。在RT前拔牙部位有暴露骨的参与者在拔牙和开始RT之间的平均时间为19.6天，而没有暴露骨的参与者为26.2天（P=.21）。
结论：在本研究中确定的具有危险因素的个体牙齿应考虑在RT前拔除HNC，在开始RT之前有足够的愈合时间。
结论：本试验的结果将有助于对接受RT治疗的HNC患者进行循证牙科管理。该临床试验已在Clinicaltrials.gov注册。注册号是NCT02057510。
方法：作者对572例接受RT治疗的HNC患者进行了一项前瞻性观察多中心队列研究。参与者在RT之前由校准的检查员检查，然后每6个月检查一次，直到RT后2年。分析了牙齿衰竭的时间和牙齿位置暴露骨的机会。
结果：以下RT前特征预测了RT后2年内的牙齿衰竭：未在RT前拔除的无望牙齿（危险比[HR]，17.1;P<.0001),未经处理的龋齿（HR，5.0;P<.0001),牙周袋6毫米或更大(HR，3.4；P=.001）或等于5mm（HR，2.2；P=.006)，衰退超过2毫米(HR，2.8；P=.002），分叉评分为2(HR，3.3；P=.003)，和任何流动性(HR，2.2；P=.008）。以下RT前特征预测了牙齿位置暴露骨的发生：在RT前没有拔除的无望牙齿（风险比[RR]，18.7;P=.0002)和凹槽深度6mm或更大(RR,5.4；P=.003）或等于5mm（RR，4.7；P=.016）。在RT前拔牙部位有暴露骨的参与者在拔牙和开始RT之间的平均时间为19.6天，而没有暴露骨的参与者为26.2天（P=.21）。
结论：在本研究中确定的具有危险因素的个体牙齿应考虑在RT前拔除HNC，在开始RT之前有足够的愈合时间。
结论：本试验的结果将有助于对接受RT治疗的HNC患者进行循证牙科管理。该临床试验已在Clinicaltrials.gov注册。注册号是NCT02057510。
