3A|
2C|
2B|
2A|
1B|
SUMMARY REVIEW/ORAL SURGERY
1A|
No trials on extraction/ non-extraction of teeth prior to radiotherapy Abstracted from Eliyas S, Al-Khayatt A, Porter RW, Briggs P. Dental extractions prior to radiotherapy to the jaws for reducing post-radiotherapy dental complications. Cochrane Database Syst Rev 2013; 2: Art. No. CD008857. DOI: 10.1002/14651858.CD008857.pub2. Address for correspondence: Luisa Fernandez Mauleffinch, Review Group Co-ordinator, Cochrane Oral Health Group, MANDEC, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester, M15 6FH, UK. E-mail: [email protected]
Question: Should diseased teeth be extracted prior to radiotherapy to the jaw?
Commentary This review attempted to support, or refute, the accepted practice of extracting teeth before starting radiation therapy on head and neck cancer patients by comparing the amount of tooth related
Data sources The Cochrane Oral Health Group’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline,
complications patients might experience after. Primary and secondary objectives were stated. One of the prima-
Embase, Cancerlit and CINAHL databases were searched.
ry objectives was to compare extraction, or conservative treatment
Study selection Randomised controlled trials comparing extraction
of ‘diseased molar teeth’. Diseased molar teeth can include a very
of teeth prior to radiotherapy with leaving teeth in situ during
broad group of conditions with different prognoses and it is not
radiotherapy to the jaws were to be selected.
clear if only diseased molar teeth, that otherwise could be restored
Data extraction and synthesis Three review authors independently
and maintained, were included.
assessed the results of the searches for inclusion in the review.
The authors followed an impeccable protocol. They performed a
Results No randomised controlled trials were found.
comprehensive search of multiple databases and hand searching. All
Conclusions There are no randomised controlled trials to assess the
authors independently reviewed the results of the search after elimi-
effect of extracting teeth prior to radiotherapy compared to leaving
nating duplicates. With no disagreement, no studies were included
teeth in the mouth during radiotherapy to the jaws.
since there were no randomised trials. Because the primary outcome was tooth related complications, one can argue that randomised control trials were not the most appropriate design to study such an outcome. Radiation therapy for treatment of head and neck cancer causes multiple acute and persistent changes affecting many tissues. Bone changes in the field of radiation, especially in the mandible, permanently increase the risk for osteoradionecrosis (ORN) with potentially devastating consequences. Extractions and infections further increase the risk for developing ORN. The authors wrote in the plain language summary ‘there is currently no evidence available to answer this complex question’. This statement may be misleading and open to wrong interpretations. Current protocols based on evidence from quality observational studies for management of head and neck cancer patients1,2,3,4 provide comprehensive criteria for dental evaluation and treatment to be used for each case individually. None of the current practices recommends systematic extraction of healthy teeth. Silvia Spivakovsky NYU College of Dentistry, New York, USA
This paper is based on a Cochrane Review published in the Cochrane Library 2013, issue 2 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the most recent version of the review.
1. Sulaiman F, Huryn JM, Zlotolow IM. Dental extractions in the irradiated head and neck patient: a retrospective analysis of Memorial Sloan-Kettering Cancer Center protocols, criteria, and end results. Oral Maxillofac Surg 2003; 61: 1123–1131. 2. Oral Complications of Chemotheraphy and Head/Neck Radiation (PDQ®). National Cancer Institute, USA http://www.cancer.gov/cancertopics/pdq/supportivecare/ oralcomplications/HealthProfessional/page15 . Last accessed 23 July 2014 3. National Institute for Health and Care Excellence. Service guidance on improving outcomes in head and neck cancers (http://www.nice.org.uk/guidance/csghn ) p. 71. Last accessed 30 July 2014 4. Diagnosis and Management of Head and Neck Cancer. Scottish Intercollegiate Guidelines Network 2006. SIGN No 90. 15.2 p.48 .
Evidence-Based Dentistry (2014) 15, 76. doi:10.1038/sj.ebd.6401035
76
© EBD 2014:15.3 © 2014 Macmillan Publishers Limited. All rights reserved
2C|
2B|
2A|
1B|
SUMMARY REVIEW/ORAL SURGERY
1A|
No trials on extraction/ non-extraction of teeth prior to radiotherapy Abstracted from Eliyas S, Al-Khayatt A, Porter RW, Briggs P. Dental extractions prior to radiotherapy to the jaws for reducing post-radiotherapy dental complications. Cochrane Database Syst Rev 2013; 2: Art. No. CD008857. DOI: 10.1002/14651858.CD008857.pub2. Address for correspondence: Luisa Fernandez Mauleffinch, Review Group Co-ordinator, Cochrane Oral Health Group, MANDEC, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester, M15 6FH, UK. E-mail: [email protected]
Question: Should diseased teeth be extracted prior to radiotherapy to the jaw?
Commentary This review attempted to support, or refute, the accepted practice of extracting teeth before starting radiation therapy on head and neck cancer patients by comparing the amount of tooth related
Data sources The Cochrane Oral Health Group’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline,
complications patients might experience after. Primary and secondary objectives were stated. One of the prima-
Embase, Cancerlit and CINAHL databases were searched.
ry objectives was to compare extraction, or conservative treatment
Study selection Randomised controlled trials comparing extraction
of ‘diseased molar teeth’. Diseased molar teeth can include a very
of teeth prior to radiotherapy with leaving teeth in situ during
broad group of conditions with different prognoses and it is not
radiotherapy to the jaws were to be selected.
clear if only diseased molar teeth, that otherwise could be restored
Data extraction and synthesis Three review authors independently
and maintained, were included.
assessed the results of the searches for inclusion in the review.
The authors followed an impeccable protocol. They performed a
Results No randomised controlled trials were found.
comprehensive search of multiple databases and hand searching. All
Conclusions There are no randomised controlled trials to assess the
authors independently reviewed the results of the search after elimi-
effect of extracting teeth prior to radiotherapy compared to leaving
nating duplicates. With no disagreement, no studies were included
teeth in the mouth during radiotherapy to the jaws.
since there were no randomised trials. Because the primary outcome was tooth related complications, one can argue that randomised control trials were not the most appropriate design to study such an outcome. Radiation therapy for treatment of head and neck cancer causes multiple acute and persistent changes affecting many tissues. Bone changes in the field of radiation, especially in the mandible, permanently increase the risk for osteoradionecrosis (ORN) with potentially devastating consequences. Extractions and infections further increase the risk for developing ORN. The authors wrote in the plain language summary ‘there is currently no evidence available to answer this complex question’. This statement may be misleading and open to wrong interpretations. Current protocols based on evidence from quality observational studies for management of head and neck cancer patients1,2,3,4 provide comprehensive criteria for dental evaluation and treatment to be used for each case individually. None of the current practices recommends systematic extraction of healthy teeth. Silvia Spivakovsky NYU College of Dentistry, New York, USA
This paper is based on a Cochrane Review published in the Cochrane Library 2013, issue 2 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the most recent version of the review.
1. Sulaiman F, Huryn JM, Zlotolow IM. Dental extractions in the irradiated head and neck patient: a retrospective analysis of Memorial Sloan-Kettering Cancer Center protocols, criteria, and end results. Oral Maxillofac Surg 2003; 61: 1123–1131. 2. Oral Complications of Chemotheraphy and Head/Neck Radiation (PDQ®). National Cancer Institute, USA http://www.cancer.gov/cancertopics/pdq/supportivecare/ oralcomplications/HealthProfessional/page15 . Last accessed 23 July 2014 3. National Institute for Health and Care Excellence. Service guidance on improving outcomes in head and neck cancers (http://www.nice.org.uk/guidance/csghn ) p. 71. Last accessed 30 July 2014 4. Diagnosis and Management of Head and Neck Cancer. Scottish Intercollegiate Guidelines Network 2006. SIGN No 90. 15.2 p.48 .
Evidence-Based Dentistry (2014) 15, 76. doi:10.1038/sj.ebd.6401035
76
© EBD 2014:15.3 © 2014 Macmillan Publishers Limited. All rights reserved
