Exposed bone in patients with head and neck cancer treated with radiation therapy: An analysis of the Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad).

BACKGROUND: Patients with head and neck cancer (HNC) treated with radiation therapy (RT) are at risk for jaw osteoradionecrosis (ORN), which is largely characterized by the presence of exposed necrotic bone. This report describes the incidence and clinical course of and risk factors for exposed intraoral bone in the multicenter Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad) cohort. METHODS: Participants were evaluated before RT and at 6, 12, 18, and 24 months after RT. Exposed bone was characterized by location, sequestrum formation, and other associated features. The radiation dose to the affected area was determined, and the history of treatment for exposed bone was recorded. RESULTS: The study enrolled 572 participants; 35 (6.1%) were diagnosed with incident exposed bone at 6 (47% of reports), 12 (24%), 18 (20%), and 24 months (8%), with 60% being sequestrum and with 7 cases (20%) persisting for >6 months. The average maximum RT dose to the affected area of exposed bone was 5456 cGy (SD, 1768 cGy); the most frequent associated primary RT sites were the oropharynx (42.9%) and oral cavity (31.4%), and 76% of episodes occurred in the mandible. The diagnosis of ORN was confirmed in 18 participants for an incidence rate of 3.1% (18 of 572). Risk factors included pre-RT extractions (P = .008), a higher RT dose (P = .039), and tobacco use (P = .048). CONCLUSIONS: The 2-year incidence of exposed bone in the OraRad cohort was 6.1%; the incidence of confirmed ORN was 3.1%. Exposed bone after RT for HNC is relatively uncommon and, in most cases, is a short-term complication, not a recurring or persistent one.

Survey of experiences and barriers to dental care post-head and neck cancer in OraRad study participants.

PURPOSE: Dental care after head and neck cancer (HNC) treatment is crucial to maintaining oral health and preventing/treating oral complications. This survey investigated the experiences and barriers to dental care post-radiation therapy (RT). METHODS: Participants of the Clinical Registry of Dental Outcomes in patients with head and neck cancer (OraRad) were surveyed at approximately 4 years post-RT. Participants completed a 20-question survey which assessed perceptions of dental care and education, barriers to receiving care, and ongoing physical symptoms post-RT. RESULTS: One hundred fifty-three of the 505 available OraRad participants completed the survey. Almost all of the respondents (n = 141; 92%) either strongly agreed or agreed that they understand the effects of cancer and its treatment on the teeth, mouth, and jaws. The majority (n = 119; 80%) strongly agreed or agreed that their dentist provided them with information on how to keep teeth, mouth, and jaws healthy after treatment. Most participants reported dry mouth (n = 114; 75%). Other sequelae were problems swallowing (n = 57; 38%), dental caries (n = 33; 22%), and difficulty keeping their mouth open during dental procedures (n = 26; 17%). CONCLUSIONS: The OraRad respondents reported few barriers to dental care post-HNC treatment. Patients continue to suffer oral/maxillofacial side effects of radiation treatment, most notably xerostomia.