A prospective cohort study found that 40% of patients undergoing dental extractions after radiation therapy for head and neck cancer developed exposed bone, a known precursor to osteoradionecrosis.

Researchers at a single academic institution assessed the safety of post-radiation dental extractions in patients with head and neck cancer. Fifty patients were enrolled between January 2020 and September 2022, all requiring extraction of nonrestorable teeth following radiation therapy (RT). Current guidelines recommend performing extractions before RT to minimize the risk of osteoradionecrosis (ORN), but this study explored whether post-RT extractions could serve as an alternative without delaying oncologic treatment.

All patients received intensity-modulated radiation therapy (IMRT). Among the patients, 64% (32 patients) received radiation therapy without surgery, while 36% (18 patients) underwent RT following surgery. Chemotherapy was used in 72% of patients. Sixty percent of the patients (30 patients) proceeded with dental extractions after RT, with a median time of 64.5 days (range, 13-152 days) following treatment. The median number of teeth extracted was 8.5, with a range of 1 to 28 extractions.

Using competing risk analysis to account for deaths, the study reported a two-year cumulative incidence of exposed bone in 27% of the entire cohort (95% confidence interval [CI], 14%–40%), with 40% of those who had post-RT extractions developing exposed bone (95% CI, 22%–58%). In contrast, patients who did not undergo extractions had a 7% (95% CI, 0%–22%) incidence of exposed bone. Out of the 13 patients with exposed bone, eight were diagnosed with ORN, leading to a two-year cumulative incidence of ORN at 18% (95% CI, 6%–30%) in the cohort, and 23% (95% CI, 8%–38%) for those who had extractions after RT.

The study found that patients who received post-radiation extractions and were treated with a mean oral cavity dose greater than 35 Gy experienced exposed bone at the highest rates.

Published in JAMA Otolaryngology–Head & Neck Surgery, the study concluded that post-RT dental extractions carry a considerable risk of complications, even when performed within the suggested four-month window. The authors suggest that post-radiation extractions should not be attempted routinely due to the high risk of exposed bone.

The researchers noted limitations of the study, including its small sample size and single-institution nature, which may affect the generalizability of the results.

Full disclosures can be found in the published study.