Princess Margaret Cancer Centre, University Health Network, 610 University Ave. Toronto, Room 2-933 - Dental Oncology and Maxillofacial Prosthetics Clinic, ON M5G 2C1, Canada; Faculty of Dentistry, Univeristy of Toronto, 124 Edward Street, room 463, Toronto, ON M5G 1G6, Canada.
Princess Margaret Cancer Centre, University Health Network, 610 University Ave. Toronto, Room 2-933 - Dental Oncology and Maxillofacial Prosthetics Clinic, ON M5G 2C1, Canada.
Oral Oncol. 2021 Dec;123:105604. doi: 10.1016/j.oraloncology.2021.105604. Epub 2021 Nov 11.
Limited evidence exists linking the specific preventative dental care provided prior to radiation therapy (RT) for head and neck cancer to outcomes like osteoradionecrosis (ORN). This study utilized expert consensus to develop tooth-specific dental treatment pathways for head and neck cancer patients prior to radiation.
Dental oncologists from across a single nation were engaged in a Modified Delphi process. Three rounds of questionnaires were performed followed by an in-person meeting. Domains included radiation dose, timing of dental treatment, and treatment of dental caries, periodontal disease and third molars.
The response rate from the 32 participants between rounds was > 70%. Consensus was reached for all but 4 questions. The radiation dose at which participants would prophylactically remove teeth to prevent ORN was established as 70 Gy in the maxilla and 60 Gy in the mandible. Treatment pathways were developed for maxillary and mandibular anterior/premolar and molar teeth receiving a dose at or above this threshold. Risk factors were established for carious, periodontally involved and third molar teeth. In general, periodontally involved teeth and mandibular molars were most frequently recommended for extraction. Only symptomatic third molars were recommended for extraction when adequate healing time was available prior to commencement of RT.
Tooth-level clinical practice guidelines were developed using expert consensus via the modified Delphi process. The treatment pathways developed in this study will be prospectively tested to evaluate the outcomes associated with tooth-specific dental treatments.
目前仅有有限的证据表明，在头颈部癌症放射治疗（RT）前提供的特定预防牙科护理与放射性骨坏死（ORN）等结果有关。本研究利用专家共识，为接受 RT 的头颈部癌症患者制定了具体牙齿的牙科治疗路径。
来自一个国家的多位肿瘤牙科医生参与了一项改良 Delphi 研究。进行了三轮问卷调查，随后举行了一次面对面会议。讨论的领域包括放射剂量、牙科治疗的时机以及龋齿、牙周病和第三磨牙的治疗。
在三轮之间，32 名参与者的回复率>70%。除了 4 个问题外，其他问题都达成了共识。参与者为预防 ORN 预防性拔牙的放射剂量被确定为上颌 70Gy 和下颌 60Gy。为接受该剂量或以上剂量的上颌和下颌前牙/前磨牙和磨牙制定了治疗路径。为龋齿、牙周炎和第三磨牙建立了风险因素。一般来说，牙周炎受累的牙齿和下颌磨牙最常被推荐拔除。只有在 RT 开始前有足够的愈合时间时，才推荐拔除有症状的第三磨牙。
通过改良 Delphi 过程利用专家共识制定了牙齿临床实践指南。本研究制定的治疗路径将前瞻性地进行测试，以评估与特定牙齿治疗相关的结果。
