Denture use and dental risk factors associated developing osteoradionecrosis after head and neck radiotherapy: A retrospective analysis of hospital records

Objectives: This study aimed to assess the association between denture use and occurrence of osteoradionecrosis (ORN) following radiotherapy for head and neck cancer (HNC). Materials and methods: Medical records of 439 HNC patients treated with radiotherapy at Guy's & St Thomas' NHS Foundation Trust (London, UK) (2014-2019) who had missing teeth at the time of discharge were reviewed. Descriptive statistics were used to summarise the participant characteristics and outcome measures. Logistic regression analysis was used to identify factors associated with occurrence of ORN. Results: Patients had an average of 14 missing teeth and 39 % wore dentures. Twenty-two (5 %) developed ORN. Out of 22 who developed ORN, 11 (50 %) wore dentures. Of these, 5 patients developed ORN in areas contacted by dentures. Denture use was not significantly associated with the occurrence of ORN (OR = 1.94; 95%CI = 0.79-4.81; p-value = 0.150). Longer duration of radiotherapy (OR = 1.03; 95%CI = 1.00-1.06; pvalue = 0.048) and more missing teeth in the lower anterior area (OR = 1.11; 95%CI = 1.01-1.22; pvalue = 0.024) were significantly associated with the development of ORN. Conclusions: Within the limitations of this single-centre study in which few patients developed ORN, denture use may not be a risk factor for ORN following radiotherapy for HNC. This is likely to be the case if dentures are well-fitting and not causing sores or irritation. Clinical significance: Replacement of the missing teeth with dentures in HNC patients post-radiotherapy may be a suitable choice for many HNC survivors. However, a powered study in a large cohort that includes clinical evaluation of dentures and the quality of fit alongside denture wearing experience would be useful to further assess the impact of denture use on the development of ORN.