Impact of Oral Health on the Incidence of Osteoradionecrosis and Oral Mucositis in Tonsil Cancer Patients Treated With Radiotherapy-A Retrospective Cohort Study

ObjectiveTo clarify the clinical significance of oral health in the occurrence of oral complications of radiotherapy in patients with tonsil cancer.Study designThis was a retrospective cohort study in patients with tonsil cancer who received radiotherapy. Oral health status was assessed from dental panoramic tomography images. The associations between age, sex, smoking and alcohol use, and regular glucocorticoid medication and the outcome variables of oral mucositis (OM) and osteoradionecrosis (ORN) were evaluated.ResultsAltogether 107 primary tonsil carcinoma patients were included in the analyses. Most patients (86%) had clinically notable radiation-induced OM. No significant associations were observed between oral health variables and OM occurrence. ORN occurred in 10% of the patients followed for at least 2 years. There was an association between ORN and oral health. Presence of teeth in poor condition was associated with ORN occurrence.ConclusionPoor oral health is linked to ORN. The association remained even when dental infections were treated before radiotherapy. These findings emphasize the role of oral bacteria and chronic inflammation in ORN. Infection-free dentition and good oral health prevent difficult complications of radiotherapy.Statement of Clinical RelevanceInfection-free dentition and good oral health prevent difficult complications of radiotherapy.