Schweyen Ramona, Heinrich Stephanie, Lückmann Sara Lena, Hey Jeremias, Fleischer Steffen
Medical Faculty, Department of Prosthodontics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
AOK Sachsen-Anhalt, Magdeburg, Germany.
BMC Oral Health. 2025 May 28;25(1):835. doi: 10.1186/s12903-025-06114-y.
Radiotherapy (RT) is a key component in the multimodal treatment approach for head and neck cancer (HNC). Post-therapeutic surgical and/or dental interventions on the jawbone carry a risk of developing osteoradionecrosis (ORN). To mitigate this risk, dental examinations and, if necessary, treatment should be conducted prior to RT. However, the consistent implementation of these recommendations in routine dental practice remains uncertain. This study aimed to evaluate whether insured persons of AOK Saxony-Anhalt (AOK ST) utilise dental services in accordance with current treatment recommendations and whether this behaviour influences the need for post-therapeutic tooth removal and the occurrence of ORN.
Anonymised health claims data were analysed from individuals newly diagnosed with HNC between 2017 and 2021, who received RT and were continuously insured by AOK ST from 1 year before the start of RT to 2022. Three dependent variables were evaluated: dental treatment prior to RT, tooth extraction after RT, and ORN occurrence. Independent variables included sex, age, tooth extraction before RT, need for care, exemption from copayment, bisphosphonate prescription, diabetes, chronic obstructive pulmonary disease, alcohol abuse, chemotherapy, and guideline adherence.
Data from 1,086 patients with HNC diagnoses (75.9% male) were analysed. The median follow-up time from the first RT was 796 days (first quartile: 316 days; third quartile: 1,210 days). Twenty-one patients (1.9%) developed ORN after RT. More than 50% of the study population received dental care in accordance with guideline recommendations prior to RT. Need for care had the most significant negative effect on the utilisation of dental treatment prior to RT.
This study did not find evidence of consistent implementation of the recommended guidelines for dental assessment/therapy prior to RT. Patients in need for care and those with chronic comorbidities were less likely to receive and/or require dental care. Although no significant influence on ORN development was observed, the reliability of this finding is limited by the small cohort size and low ORN incidence. Further studies with larger cohorts are needed to validate these findings.
放射治疗（RT）是头颈癌（HNC）多模式治疗方法的关键组成部分。对颌骨进行治疗后的外科手术和/或牙科干预存在发生放射性骨坏死（ORN）的风险。为降低这种风险，应在放疗前进行牙科检查，并在必要时进行治疗。然而，这些建议在常规牙科实践中的持续实施情况仍不确定。本研究旨在评估萨克森-安哈尔特州AOK（AOK ST）的参保人员是否按照当前治疗建议使用牙科服务，以及这种行为是否会影响治疗后拔牙的需求和ORN的发生。
分析了2017年至2021年间新诊断为HNC、接受放疗且从放疗开始前1年至2022年一直由AOK ST持续承保的个体的匿名健康理赔数据。评估了三个因变量：放疗前的牙科治疗、放疗后的拔牙以及ORN的发生。自变量包括性别、年龄、放疗前拔牙、护理需求、免付共付费用、双膦酸盐处方、糖尿病、慢性阻塞性肺疾病、酗酒、化疗以及指南依从性。
分析了1086例HNC诊断患者的数据（75.9%为男性）。从首次放疗开始的中位随访时间为796天（第一四分位数：316天；第三四分位数：1210天）。21例患者（1.9%）在放疗后发生ORN。超过50%的研究人群在放疗前按照指南建议接受了牙科护理。护理需求对放疗前牙科治疗的利用产生了最显著的负面影响。
本研究未发现放疗前牙科评估/治疗推荐指南得到一致实施的证据。有护理需求的患者和患有慢性合并症的患者接受和/或需要牙科护理的可能性较小。尽管未观察到对ORN发生有显著影响，但这一发现的可靠性受到队列规模小和ORN发病率低的限制。需要进一步开展更大队列的研究来验证这些发现。
