Dental treatments for preventing damage to the jawbones in people with cancer receiving radiotherapy to the head and neck

Mohamed El‐Rabbany, Michael Duchnay, Hamid Reza Raziee, Maria Zych, Howard Tenenbaum, Prakeshkumar S Shah, Amir Azarpazhooh

Review question

With this Cochrane Review we tried to find out the best way to prevent the death and exposure of bone in the jaws of people who have had radiotherapy for head and neck cancer. This is a condition called osteoradionecrosis (ORN).

Background

ORN of the jaws is a serious problem which can happen after people have radiotherapy as part of their treatment for head and neck cancer. ORN refers to the death and exposure of bone that result from damage to the tissues due to being exposed to radiation. ORN is very difficult to treat and it is important that steps are taken to prevent it. In this review, we looked at any treatments that have been used to prevent ORN.

Study characteristics

This review is up‐to‐date as of 5 November 2019. The review includes four studies involving 342 adults who had received radiotherapy for the treatment of head and neck cancer. The review looks at three different ways to prevent ORN:

‐ the use of platelet‐rich plasma (PRP) in bone after removal of healthy teeth prior to radiotherapy. Plasma is a part of blood that contains special proteins that help the blood to clot, and PRP is concentrated plasma which supports cell growth. Injecting PRP into damaged tissue may stimulate the body to grow new, healthy cells to make it heal more quickly;

‐ taking out teeth because of tooth decay makes the risk of developing ORN greater. Preventing tooth decay in people having radiotherapy is very important. We looked at a study comparing using fluoride gel with a toothpaste with a higher level of fluoride than normal to prevent tooth decay after radiotherapy;

‐ hyperbaric oxygen therapy is breathing oxygen in a pressurized chamber to improve blood supply, which may help heal damaged tissue. Two studies compared the use of hyperbaric oxygen therapy for taking out teeth or placing dental implants with antibiotics. Antibiotics are drugs which stop or slow the growth of bacteria.

Key results

One study showed no reduction in ORN when using platelet‐rich plasma in bone after the removal of healthy teeth. Another study found no difference between fluoride gel and toothpaste with a higher level of fluoride than normal as no cases of ORN were reported. A third study showed that treatment with hyperbaric oxygen therapy caused a reduction in the development of ORN in comparison to patients treated with antibiotics following the removal of teeth. The fourth study found no difference between combined hyperbaric oxygen therapy and antibiotics compared to antibiotics alone.

Harmful effects of the different interventions were not reported clearly or were not important.

Certainty of the evidence

The level of certainty we have in these findings is very low. This was due to high risk of bias, not all studies mentioning important details, and the small number of people studied in the four included trials.

Conclusion

We do not have enough evidence to say which intervention works better to stop ORN of the jaws from happening or making it less severe in adults receiving head and neck radiotherapy. We suggest that more, well‐conducted, and bigger studies including more people, should be done in this area.

Read the full review.

El‐Rabbany  M, Duchnay  M, Raziee  HR, Zych  M, Tenenbaum  H, Shah  PS, Azarpazhooh  A. Interventions for preventing osteoradionecrosis of the jaws in adults receiving head and neck radiotherapy. Cochrane Database of Systematic Reviews 2019, Issue 11. Art. No.: CD011559. DOI: 10.1002/14651858.CD011559.pub2.