Presentations 2020: Restorative

381 - Audit of the pre-radiotherapy dental extraction timings and subsequent incidence of osteoradionecrosis

Richard Newton James Owens Ushma Patel
Presented by: Richard Newton
Morriston Hospital

Introduction The aim our audit was to assess the compliance of the timing of dental extractions prior to radiotherapy within our unit with the 2018 guidelines from The Royal College of Surgeons of England/The British Society for Disability and Oral Health. We also examined the incidence of osteoradionecrosis attributable to the pre-radiotherapy extractions. Method All patient notes (353) from a two year period of oncology dental assessments (17/10/17 to 17/10/19) were retrospectively analysed. We included all patients (75) who had extractions prior to radiotherapy within the unit’s maxillo-facial department under local anaesthetic. Patients who had extractions outside the unit, at the time of surgery, or received less than 50 Gy were excluded. Patients were reviewed at least 3 months after completing radiotherapy to assess the incidence of osteoradionecrosis. Results The mean number of days from dental assessment to commencing radiotherapy was 35.9 days (range 11-70), from assessment to the first extraction/s was 7.1 days (range -8-29), and from the last extraction to starting radiotherapy was 27.2 days (range 5-62). Two patients had extractions less than 10 days prior to radiotherapy, meaning 97% complied with the guidelines. 99% (74) of patients were reviewed at least 3 months post radiotherapy. 3 cases of ORN (4.1%) occurred with patients receiving extractions 28, 14, and 11 days prior to radiotherapy. All occurred in the body of mandible within the primary field of the radiotherapy. Conclusion The pathway appears to be working well and complying with the guidelines. Our 4.1% incidence of osteoradionecrosis directly attributable to pre-radiotherapy extractions is similar to the findings of a 2014 systematic review which demonstrated an incidence of 4.16%. In order to continue to improve we need to: • Develop a protocol to identify and highlight possible high risk patients and consider extended healing times • Communicate this clearly between teams • Re-audit
Consent Statement: There are no details on individual patients reported within the abstract.

Video