Is Tooth Extraction Safe After Radiotherapy for Head and Neck Cancer?

Although radiotherapy effectively controls tumors in head and neck cancer, it can cause long-term adverse effects on oral health. In these patients, even a seemingly simple procedure such as tooth extraction after radiotherapy may lead to serious complications. Osteoradionecrosis is a particular concern, reducing quality of life and complicating treatment. Whether teeth should be extracted before or after radiotherapy has therefore long been debated. A new study aims to clarify this uncertainty by evaluating the safety and potential risks of extractions performed after radiotherapy.

A study of the safety of tooth extraction after radiotherapy for head and neck cancer, published on August 8, 2024 in JAMA Otolaryngology – Head & Neck Surgery, found that the procedure increases the risk of exposed bone and osteoradionecrosis (loss of bone tissue) in patients receiving high radiation doses.

"Exposed bone means bone tissue is left uncovered by the soft tissue and skin that would normally cover it. After radiotherapy, bone exposure in areas such as the mouth may be a warning sign of osteoradionecrosis (bone death) and can lead to serious complications.

Why the Study Matters

To prevent serious complications such as osteoradionecrosis in patients receiving treatment for head and neck cancer, extraction of irreversibly damaged teeth is generally recommended before radiotherapy. However, this procedure can delay treatment by 2-4 weeks, potentially reducing survival rates. Although extraction after radiotherapy is offered as an alternative, there are insufficient data on its safety.

Study Methods and Findings

The study examined 50 patients receiving treatment for head and neck cancer between January 2020 and September 2022. Researchers assessed the safety of tooth extraction within the first 4 months after radiotherapy and whether it increased the risk of bone exposure and osteoradionecrosis. Patients were followed for a median of 26 months.

Of the patients enrolled, 30 underwent extraction of 1 to 28 teeth after radiotherapy. Extractions were performed a median of 64.5 days after radiotherapy (range 13-152 days). The other 20 patients avoided extraction. Among those who underwent extraction, 13 developed exposed bone and 8 developed osteoradionecrosis.

Over 2 years of follow-up:

• The risk of bone exposure was 27% across all patients,
• 40% among those undergoing extraction,
• and 7% among those not undergoing extraction.

The risk of osteoradionecrosis was:

• 18% across all patients,
• 23% among those undergoing extraction,
• and 7% among those not undergoing extraction.

In patients who underwent extraction after radiotherapy, particularly when the mean oral cavity dose was 35 Gy or higher, the risk of exposed bone was 58% and the risk of osteoradionecrosis was 39%. Similarly, doses of 31.5 Gy or higher to the mandible (lower jaw) increased the frequency of these adverse effects.

Conclusion and Clinical Application

Based on these findings, routine tooth extraction after radiotherapy is not recommended. Particularly in patients receiving high radiation doses to the oral cavity or mandible, the procedure's potential to cause serious complications such as exposed bone and osteoradionecrosis must be considered.

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Related Topic: Cancer and Dental Treatment: What Should People Taking Bone-Protective Medicines Watch For?