Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA.
Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
JDR Clin Trans Res. 2023 Jul;8(3):234-243. doi: 10.1177/23800844221086563. Epub 2022 Apr 11.
Treatment for head and neck cancer (HNC) such as radiotherapy (RT) can lead to numerous acute and chronic head and neck sequelae, including dental caries. The goal of the present study was to measure 2-y changes in dental caries after radiotherapy in patients with HNC and test risk factors for caries increment.
Cancer and dental disease characteristics, demographics, and oral health practices were documented before and 6, 12, 18, and 24 mo after the start of RT for 572 adult patients with HNC. Patients were eligible if they were age 18 y or older, diagnosed with HNC, and planned to receive RT for treatment of HNC. Caries prevalence was measured as decayed, missing, and filled surfaces (DMFS). The association between change in DMFS and risk factors was evaluated using linear mixed models.
On average, DMFS increased from baseline to each follow-up visit: 6 mo, +1.11; 12 mo, +2.47; 18 mo, +3.43; and 24 mo, +4.29 ( < 0.0001). The increase in DMFS during follow-up was significantly smaller for the following patient characteristics: compliant with daily fluoride use ( = 0.0004) and daily oral hygiene (brushing twice daily and flossing daily; = 0.015), dental insurance ( = 0.004), and greater than high school education ( = 0.001). DMFS change was not significantly associated with average or maximum RT dose to the parotids ( > 0.6) or salivary flow ( > 0.1). In the subset of patients who had salivary hypofunction at baseline ( = 164), lower salivary flow at follow-up visits was associated with increased DMFS.
Increased caries is a complication soon after RT in HNC. Fluoride, oral hygiene, dental insurance, and education level had the strongest association with caries increment after radiotherapy to the head and neck region. Thus, intensive oral hygiene measures, including fluoride and greater accessibility of dental care, may contribute to reducing the caries burden after RT in HNC.
The results of this study can be used by clinicians when deciding how to minimize oral complications related to cancer therapy for patients with head and neck cancer. Identification of modifiable factors (e.g., oral hygiene and prescription fluoride compliance) associated with increased caries risk can minimize radiation caries burden.
头颈部癌症（HNC）的治疗，如放疗（RT），可导致许多急性和慢性头颈部后遗症，包括龋齿。本研究的目的是测量 HNC 患者放疗后 2 年内龋齿的变化，并检测龋齿增量的危险因素。
对 572 例接受 HNC 放疗的成年患者的癌症和口腔疾病特征、人口统计学资料和口腔保健措施进行了记录，记录时间分别为放疗开始前和放疗后 6、12、18 和 24 个月。如果患者年龄在 18 岁或以上、诊断为 HNC 且计划接受 RT 治疗 HNC，则有资格参加该研究。龋齿的患病率用龋失补牙面数（DMFS）来衡量。采用线性混合模型评估 DMFS 变化与危险因素之间的关系。
平均而言，DMFS 从基线到每次随访均有增加：6 个月时，+1.11；12 个月时，+2.47；18 个月时，+3.43；24 个月时，+4.29（<0.0001）。以下患者特征的 DMFS 随访期间增加幅度较小：每天使用氟化物（=0.0004）和每天口腔卫生（每天刷牙两次和使用牙线；=0.015）、牙齿保险（=0.004）和高中以上教育（=0.001）。DMFS 变化与腮腺（>0.6）或唾液流量（>0.1）的平均或最大 RT 剂量无显著相关性。在基线时有唾液分泌功能低下的患者亚组中（=164），随访时唾液流量较低与 DMFS 增加相关。
放疗后不久，龋齿是 HNC 的一种并发症。氟化物、口腔卫生、牙齿保险和教育水平与头颈部放疗后龋齿的增加有最强的相关性。因此，强化口腔卫生措施，包括氟化物和更大程度地获得口腔保健，可能有助于降低 HNC 放疗后的龋齿负担。
本研究的结果可供临床医生在为头颈部癌症患者决定如何最小化癌症治疗相关的口腔并发症时使用。识别与龋齿风险增加相关的可改变因素（例如口腔卫生和处方氟化物的依从性）可以最小化辐射性龋齿负担。
