Katsura Kouji, Sasai Keisuke, Sato Katsuro, Saito Mikiko, Hoshina Hideyuki, Hayashi Takafumi
Division of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Jun;105(6):731-8. doi: 10.1016/j.tripleo.2007.10.011. Epub 2008 Mar 10.
Oral health status is a risk factor for postradiation bone complications (also known as osteoradionecrosis [ORN]), and oral health care is an important element in the prevention of this condition. Some authors recommend extracting teeth with a questionable prognosis and either gross mobility or periodontal disease. However, the criteria for making such decisions remain to be elucidated. In addition, the specific details of the association between oral health status and ORN have not yet been clearly demonstrated. The purpose of this study was to clarify the relationship between oral health status and the development of ORN.
Thirty-nine head and neck cancer patients whose radiation fields included both the teeth and the mandible were followed for > or = 3 years after radiotherapy. Among these patients, 6 suffered from ORN (ORN group), and the other 33 did not experience the condition (non-ORN group). We analyzed the patient factors, radiation factors, and oral health factors related to the complication.
The onset of ORN occurred from 18 months to 51 months after radiotherapy. The radiation dose in the oral cavity and the oral health status before radiotherapy were not significant risk factors for ORN. However, the oral health status at 1 year or 2 years after radiotherapy was significantly associated with the development of ORN. The oral health conditions that increased the risk of ORN were > 5 mm periodontal pocket depth, > 40% dental plaque score, > 60% alveolar bone loss level, and a grade 3 radiographic periodontal status.
This is the first report to show the changes in the oral health status before and after radiotherapy regarding the development of ORN. The results support the periodontal status that almost all clinicians agree on as indications for preradiation teeth extraction (namely, periodontal pockets of > 5 mm) to prevent ORN. Good oral health status, especially after radiotherapy, is very important in the prevention of ORN, and we recommend periodical dental management and care by well trained dentists and dental hygienists to avoid the condition.
口腔健康状况是放疗后骨并发症（也称为放射性骨坏死[ORN]）的一个危险因素，口腔保健是预防这种情况的重要因素。一些作者建议拔除预后可疑且有明显松动或牙周疾病的牙齿。然而，做出此类决定的标准仍有待阐明。此外，口腔健康状况与ORN之间关联的具体细节尚未得到明确证实。本研究的目的是阐明口腔健康状况与ORN发生之间的关系。
对39例放疗野包括牙齿和下颌骨的头颈癌患者进行放疗后≥3年的随访。在这些患者中，6例发生ORN（ORN组），另外33例未发生该情况（非ORN组）。我们分析了与该并发症相关的患者因素、放疗因素和口腔健康因素。
ORN发病发生在放疗后18个月至51个月。口腔内的放疗剂量和放疗前的口腔健康状况不是ORN的显著危险因素。然而，放疗后1年或2年的口腔健康状况与ORN的发生显著相关。增加ORN风险的口腔健康状况包括牙周袋深度>5mm、牙菌斑评分>40%、牙槽骨吸收水平>60%以及牙周影像学分级为3级。
这是第一份显示放疗前后口腔健康状况变化与ORN发生关系的报告。结果支持了几乎所有临床医生都认同的作为放疗前拔牙指征的牙周状况（即牙周袋>5mm）以预防ORN。良好的口腔健康状况，尤其是放疗后，对预防ORN非常重要，我们建议由训练有素的牙医和口腔保健员进行定期的牙齿管理和护理以避免该情况。
