Hannover Medical School, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
J Evid Based Dent Pract. 2024 Sep;24(3):101989. doi: 10.1016/j.jebdp.2024.101989. Epub 2024 Mar 16.
Radiotherapy to the head and neck region (HN) bears the risk of a rampant development of caries, making intensified prevention necessary. Aim of this systematic review was to summarize the evidence on the efficacy of caries preventive measures in these patients.
Clinical studies investigating caries in patients with radiotherapy in the HN with at least 1 caries preventive intervention compared to any control were included. Reports in languages other than English or German were excluded. Records were identified on PubMed, Web of Science, Google Scholar, and Cochrane Library mid-January 2024. Risk of bias was assessed with RoB2. Results were summarized. Planned meta-analyses could not be performed, because of heterogenous data.
Five studies were included, with a total of 355 participants. They were irradiated with up to 70 Gy and received different caries preventive interventions, including sodium fluoride or stannous fluoride gels, remineralizing solutions, an "Intraoral Fluoride Release System" and sucrose restricted diet. Caries score increased between 0.48 DMF-S and 9.2 DF-S per year. Largest differences in caries increments were measured between groups with insufficient and with rigorous fluoride application.
The main limitations were compromised randomization, heterogeneity of patients and small sample sizes. Clinical studies on caries prevention after radiotherapy to the HN are lacking and the existing ones bear extensive limitations. However, the large effect size and broad consensus suggest the use of fluoride to be indispensable in preventing caries in these patients. The study was funded by the Medical Center - University of Freiburg and was not registered.
头颈部区域（HN）的放射治疗有猖獗性龋齿发展的风险，因此需要强化预防。本系统评价的目的是总结关于这些患者中龋齿预防措施的疗效的证据。
纳入了至少有 1 种龋齿预防干预措施与任何对照组相比，研究 HN 放疗患者龋齿的临床研究。排除了非英语或德语的报告。记录于 2024 年 1 月中旬在 PubMed、Web of Science、Google Scholar 和 Cochrane Library 中进行了检索。使用 RoB2 评估偏倚风险。结果进行了总结。由于数据的异质性，无法进行计划的荟萃分析。
共纳入了 5 项研究，共有 355 名参与者。他们接受了高达 70 Gy 的放射治疗，并接受了不同的龋齿预防干预措施，包括氟化钠或氟化亚锡凝胶、再矿化溶液、“口腔内氟化物释放系统”和蔗糖限制饮食。龋齿评分每年增加 0.48 DMF-S 至 9.2 DF-S。氟化物应用不足和严格的氟化物应用之间的龋齿增量差异最大。
主要的局限性是随机分组受损、患者异质性和样本量小。缺乏针对 HN 放疗后龋齿预防的临床研究，现有的研究存在广泛的局限性。然而，大的效应量和广泛的共识表明，在这些患者中使用氟化物预防龋齿是不可或缺的。该研究由弗赖堡大学医学中心资助，未进行注册。
