Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Research
  • Published:

Incidence of new carious lesions and tooth loss in head and neck cancer patients: a retrospective case series from a single unit

British Dental Journal volume 229, pages 539–543 (2020)Cite this article

Abstract

Introduction Radiation-induced xerostomia can result in increased caries incidence, necessitating more dental extractions and a resultant increased risk of debilitating osteoradionecrosis (ORN). Patients undergoing head and neck radiotherapy are routinely treated with a topical preventative regime consisting of fluoride and CPP-ACP (Tooth Mousse). There is limited evidence specifically relating to fluoride prevention regimes in head and neck cancer patients. Other novel remineralising aids using calcium and phosphate have been proposed for use in head and neck cancer patients, but again, there is limited evidence.

Aims To retrospectively analyse head and neck cancer patients treated with radiotherapy and placed on a fluoride/CPP-ACP prevention regime at a single institution. To assess the incidence of caries, extractions and ORN.

Materials and methods Case records for 95 patients were retrospectively assessed. This involved review of paper and computerised clinical notes, correspondence letters and radiographs.

Results The mean number of carious teeth was 6.63 (SD 6.81) and the mean number of extractions was 4.88 (SD 5.84). The teeth most frequently affected by caries and extractions were the mandibular incisors, and 28.4% of patients developed ORN (81.5% of cases occurring in the mandible).

Conclusion Development of caries and extraction was a very common event. There is a need for further research into the efficacy of topical prevention regimes.

Key points

  • Retrospective case series from a single unit identifying cases of caries, extractions and osteoradionecrosis in head and neck cancer patients.

  • Highlights a lack of high-quality research in fluoride prevention programmes in this group of patients.

  • Highlights the need for further research to assess the efficacy of fluoride prevention regimes in head and neck cancer patients and includes a suggested template.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Appendix 1

Similar content being viewed by others

References

  1. Cancer Research UK. Head and neck cancers diagnosis and treatment statistics. 2017. Available at https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers/diagnosis-and-treatment (accessed March 2020).

  2. Restorative Dentistry UK. Predicting and managing oral and dental complications of surgical and non-surgical treatment for head and neck cancer: a clinical guideline. 2016. Available at https://www.restdent.org.uk/uploads/RD-UK%20H%20and%20N%20guideline.pdf (accessed March 2020).

  3. Kufta K, Forman M, Swisher-McClure S, Sollecito T P, Panchal N. Pre-Radiation dental considerations and management for head and neck cancer patients. Oral Oncology 2018; 76: 42-51.

  4. Kalavrezos N, Scully C. Mouth cancer for clinicians part 10: cancer treatment (surgery). Dent Update 2016; 43: 375-387.

  5. Kalavrezos N, Scully C. Mouth cancer for clinicians part 12: cancer treatment (chemotherapy and targeted therapy). Dent Update 2016; 43: 567-574.

  6. Del Regato J A. Dental lesions observed after roentgen therapy in cancer of the buccal cavity, pharynx and larynx. Am J Roentgenol 1939; 42: 404-410.

  7. Kielbassa A M, Hinkelbein W, Hellwig E, Meyer-Lückel H. Radiation-related damage to dentition. Lancet Oncol 2006; 7: 326-335.

  8. Marinho V C, Higgins J P, Sheiham A, Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2004; DOI: 10.1002/14651858.CD002781.pub2.

  9. Marinho V C, Worthington H V, Walsh T, Clarkson J E. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2013; DOI: 10.1002/14651858.CD002279.pub2.

  10. Marinho V C, Chong L Y, Worthington H V, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2016; DOI: 10.1002/14651858.CD002284.pub2.

  11. Walsh T, Worthington H V, Glenny A M, Marinho V C, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev 2019; DOI: 10.1002/14651858.CD007868.pub3.

  12. McCaul L K. Oral and dental management for head and neck cancer patients treated by chemotherapy and radiotherapy. Dent Update 2012; 39: 135-140.

  13. Noone J, Barclay C. Head and neck cancer patients-information for the general dental practitioner. Dent Update 2017; 44: 209-215.

  14. Hackett S, Jones O, Chatzistavrianou D, Newsum D. Head and neck cancer part 3: dental management. Dent Update 2019; 46: 1031-1040.

  15. Deng J, Jackson L, Epstein J B, Migliorati C A, Murphy B A. Dental demineralization and caries in patients with head and neck cancer. Oral Oncol 2015; 51: 824-831.

  16. Papas A, Russell D, Singh M, Kent R, Triol C, Winston A. Caries clinical trial of a remineralising toothpaste in radiation patients. Gerodontology 2008; 25: 76-88.

  17. Sim C P, Wee J, Xu Y, Cheung Y B, Soong Y L, Manton D J. Anti-caries effect of CPP-ACP in irradiated nasopharyngeal carcinoma patients. Clin Oral Investig 2015; 19: 1005-1011.

  18. Raphael S, Blinkhorn A. Is there a place for Tooth Mousse in the prevention and treatment of early dental caries? A systematic review. BMC Oral Health 2015; 15: 113.

  19. Beacher N G, Sweeney M P. The dental management of a mouth cancer patient. Br Dent J 2018; 225: 855-864.

  20. Toljanic J A, Heshmati R H, Bedard J F. Dental follow-up compliance in a population of irradiated head and neck cancer patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93: 35-38.

  21. Brennan M.T, Spijkervet, F K L, Elting L S. Systematic reviews and guidelines for oral complications of cancer therapies: current challenges and future opportunities. Support Care Cancer 2010; 18: 977-978.

  22. Horiot J C, Schraub S, Bone M C et al. Dental preservation in patients irradiated for head and neck tumours: a 10-year experience with topical fluoride and a randomized trial between two fluoridation methods. Radiother Oncol 1983; 1: 77-82.

  23. Frydrych A M, Slack-Smith L M, Parsons R. Compliance of post-radiation therapy head and neck cancer patients with caries preventive protocols. Aust Dent J 2017; 62: 192-199.

  24. Sulaiman F, Huryn J M, Zlotolow I M. Dental extractions in the irradiated head and neck patient: a retrospective analysis of Memorial Sloan-Kettering Cancer Centre protocols, criteria, and end results. J Oral Maxillofac Surg 2003; 61: 1123-1131.

  25. Käyser A F. Shortened dental arches and oral function. J Oral Rehabil 1981; 8: 457-462.

  26. Reuther T, Schuster T, Mende U, Kübler A. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients-a report of a thirty year retrospective review. Int J Oral Maxillofac Surg 2003; 32: 289-295.

  27. Nabil S, Samman N. Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113: 54-69.

  28. Ray-Chaudhuri A, Shah K, Porter R J. The oral management of patients who have received radiotherapy to the head and neck region. Br Dent J 2013; 214: 387-393.

  29. Thariat J, Ramus L, Darcourt V et al. Compliance with fluoride custom trays in irradiated head and neck cancer patients. Support Care Cancer 2012; 20: 1811-1814.

Download references

Author information

Authors and Affiliations

  1. General Dental Practitioner, Huddersfield, UK

    Martin Breslin

  2. University Dental Hospital of Manchester, Restorative, Higher Cambridge Street, Manchester, M15 6FH, UK

    Carly Taylor

Authors
  1. Martin Breslin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carly Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Breslin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Breslin, M., Taylor, C. Incidence of new carious lesions and tooth loss in head and neck cancer patients: a retrospective case series from a single unit. Br Dent J 229, 539–543 (2020). https://doi.org/10.1038/s41415-020-2222-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41415-020-2222-2

This article is cited by

Search

Advanced search

Quick links