Chang C T, Liu S P, Muo C H, Tsai C H, Huang Y F
1 Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan.
2 School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
J Dent Res. 2017 May;96(5):531-538. doi: 10.1177/0022034516687282. Epub 2017 Jan 17.
The aim of this study was to investigate the association of different dental prophylactic modalities and osteoradionecrosis (ORN) and determine the risk of ORN under different timing periods of scaling, with the use chlorhexidine mouth rinse after surgery and with different strategies of fluoride gel application in head and neck cancer (HNC) participants. A cohort of 18,231 HNC participants, including 941 ORN patients and 17,290 matched control cases, were enrolled from a Longitudinal Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) in Taiwan. Based on different dental prophylactic modalities before radiotherapy, including chlorhexidine mouth rinse, scaling, and fluoride gel, all HNC subjects were stratified into different groups. The Cox proportional hazard regression was used to compare ORN incidences under different dental prophylactic modalities. The results revealed that scaling and chlorhexidine mouth rinse were significantly related to ORN risk ( P = 0.004 and P < 0.0001). Chlorhexidine mouth rinse was highly correlated to ORN occurrence (hazard ratio [HR], 1.83-2.66), as exposure increased the risk by 2.43-fold among oral cancer patients, regardless of whether they had received major oral surgery or not. Oral cancer patients receiving scaling within 2 wk before radiotherapy increased their incidence of ORN by 1.28-fold compared with patients who had not undergone scaling within 6 mo. There is no significance of fluoride application for dental prophylaxis in increasing ORN occurrence. In conclusion, dental prophylaxis before radiotherapy is strongly correlated to ORN in HNC patients. Chlorhexidine exposure and dental scaling within 2 wk before radiotherapy is significantly related to ORN risk, especially in oral cancer patients. The use of 1.1% NaF topical application did not significantly increase the risk of ORN in HNC patients. An optimal dental prophylaxis protocol to reduce ORN should concern cancer location, cautious prescription of chlorhexidine mouth rinse, and proper timing of scaling.
本研究旨在调查不同牙齿预防方式与放射性骨坏死（ORN）之间的关联，并确定在头颈部癌症（HNC）患者中，不同洗牙时间、术后使用洗必泰漱口水以及不同氟凝胶应用策略下ORN的风险。我们从台湾重大伤病患者纵向健康保险数据库（LHID-CIP）中纳入了18231名HNC患者，其中包括941名ORN患者和17290名匹配的对照病例。根据放疗前不同的牙齿预防方式，包括洗必泰漱口水、洗牙和氟凝胶，将所有HNC受试者分为不同组。采用Cox比例风险回归比较不同牙齿预防方式下的ORN发病率。结果显示，洗牙和洗必泰漱口水与ORN风险显著相关（P = 0.004和P < 0.0001）。洗必泰漱口水与ORN发生高度相关（风险比[HR]，1.83 - 2.66），无论口腔癌患者是否接受过大手术，随着暴露增加，ORN风险增加2.43倍。放疗前2周内接受洗牙的口腔癌患者，其ORN发病率比6个月内未洗牙的患者增加了1.28倍。氟化物用于牙齿预防对增加ORN发生率无显著意义。总之，放疗前的牙齿预防与HNC患者的ORN密切相关。放疗前2周内接触洗必泰及洗牙与ORN风险显著相关，尤其是口腔癌患者。1.1% NaF局部应用并未显著增加HNC患者的ORN风险。减少ORN的最佳牙齿预防方案应考虑癌症部位、谨慎开具洗必泰漱口水处方以及适当的洗牙时间。
