A prospective clinical study of the influence of dental and salivary gland radiation dose on dental caries development in patients with head and neck cancer

Objectives
This prospective cohort study investigated the effect of dental and salivary gland radiation dose on the incidence and severity of dental caries among post-radiotherapy head and neck cancer (HANC) patients.

Methods
The study commenced in December 2018. Eligible patients were assessed and rendered dentally fit pre-radiotherapy. Patients were followed-up at 6-months and 12-months post-radiotherapy. Oral health data were collected via clinical assessment and validated questionnaires. The radiation doses of the teeth and salivary glands were determined by a blinded assessor.

Results
Data from 151 patients is presented (n=151). The mean age of the sample was 59.3 (SD 10.4) years. Approximately half (49.0%) of patients presented with new carious lesions 6-12 months post-radiotherapy. The mean number of carious teeth was 3.7 (SD 4.1). Multivariate statistical testing revealed that patients with: (i) continued intake of high-sugar dietary supplements (p≤0.020), (ii) daily consumption of tea/coffee with added sugar (p≤0.023), and (iii) the presence of pre-radiotherapy caries (p≤0.012), had an increased odds of post-radiotherapy caries. At the dental-sextant level (n=644), a 10-unit increase in mean (p≤0.027) and maximum (p≤0.006) dental radiation doses (Gray) were associated with a 26-32% increase in the odds of post-radiotherapy caries after adjusting for other variables. The radiation dose exposure of the parotid glands was found to have no effect on the incidence or severity of post-radiotherapy caries.

Conclusions
Post-radiotherapy HANC patients experience high levels of dental disease. Increased dental radiation dose, previous caries experience, and the continued intake of dietary supplements may increase patients’ risk of post-radiotherapy caries.