Section of Oral Medicine, University of Connecticut Health, Farmington, CT, USA.
Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, MA, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2022 May;133(5):539-546. doi: 10.1016/j.oooo.2022.01.016. Epub 2022 Jan 31.
The aim of this study was to examine effects of radiation therapy (RT) for head and neck cancer (HNC) on periodontal disease and relationships to caries.
A multicenter prospective observational cohort study (OraRad) was conducted in patients undergoing RT for HNC. Assessments were conducted by calibrated examiners at the pre-RT (baseline) visit (n = 533), the 12-month visit (n = 414), and the 24-month visit (n = 365).
The average whole mouth mean (standard error (SE)) distance from the cementoenamel junction to the gingival margin (CEJ-GM) decreased significantly from 0.43 (0.04) mm at baseline to 0.24 (0.04) mm at 12 months and 0.11 (0.04) mm at 24 months (P ≤ .001). Whole mouth mean (SE) percentage of sites with CEJ-GM distance of <0 mm increased significantly from 23.3% (1.0%) at baseline to 28.5% (1.0%) at 12 months and 30.5% (1.1%) at 24 months (P ≤ .02). Higher mean radiation dose to the mandible was associated with a greater increase in the percentage of mandibular sites with CEJ-GM distance of <0 mm (P = .003). Both mean CEJ-GM distance and the percentage of sites with a CEJ-GM distance <0 mm were strongly associated with whole mouth mean proportion of decayed, missing, and filled surfaces, as well as proportion of decayed or filled facial/buccal surfaces specifically, (P < .001), with greater gingival recession associated with increased caries.
RT for HNC leads to mandibular gingival recession in a dose-dependent manner. This gingival recession may contribute to increased risk for cervical caries seen in these patients.
本研究旨在探讨头颈部癌症（HNC）放射治疗（RT）对头颈部癌症患者牙周病的影响及其与龋齿的关系。
一项多中心前瞻性观察队列研究（OraRad）在接受 HNC RT 的患者中进行。由经过校准的检查人员在 RT 前（基线）访视（n=533）、12 个月访视（n=414）和 24 个月访视（n=365）时进行评估。
从基线时的 0.43（0.04）mm 到 12 个月时的 0.24（0.04）mm 和 24 个月时的 0.11（0.04）mm，整个口腔的平均（标准误差（SE））从牙釉质牙骨质界到牙龈缘（CEJ-GM）的距离明显减小（P ≤.001）。整个口腔的平均（SE）CEJ-GM 距离<0mm 的位点百分比从基线时的 23.3%（1.0%）显著增加到 12 个月时的 28.5%（1.0%）和 24 个月时的 30.5%（1.1%）（P ≤.02）。下颌骨接受的平均辐射剂量越高，CEJ-GM 距离<0mm 的下颌骨位点百分比增加越大（P=.003）。CEJ-GM 距离的平均值和 CEJ-GM 距离<0mm 的位点百分比均与整个口腔的龋齿、缺失和填补的表面比例以及特别是牙面/颊面龋齿或填补的表面比例密切相关（P<.001），更大的牙龈退缩与龋齿的增加相关。
HNC 的 RT 以剂量依赖的方式导致下颌牙龈退缩。这种牙龈退缩可能导致这些患者中出现更多的颈龋风险。
