Incidence of complicated healing and osteoradionecrosis following tooth extraction in patients receiving radiotherapy for treatment of nasopharyngealcarcinoma

A group of 43 patients requiring tooth extraction after radiotherapy for na sopharyngeal carcinoma (NPC) was studied retrospectively to determine the i ncidence of post-extraction complications. It was found that because of the method used in the delivery of radiation, extraction of maxillary posterio r teeth resulted in the greatest risk of complications (28.9 per cent), inc luding a 10.5 per cent risk of osteoradionecrosis (ORN). Based on the findi ngs, a protocol was established for the dental care of such patients. It wa s concluded that when extraction of maxillary posterior teeth was necessary , prophylactic antibiotics were not sufficient to prevent the complication of delayed healing. the risk of ORN was 10.5 per cent within the field of m aximal radiation dose. Hyperbaric oxygen may be the better choice of preven tive measures. However, in view of the low risk of ORN, wholesale prescript ion of hyperbaric oxygen therapy may not be indicated. An additional patien t who had tooth extraction two weeks prior to radiotherapy was included to show that if adequate time for wound healing was not allowed, ORN could dev elop.