Analysis of health insurance data on dental treatment and the occurrence of osteoradionecrosis of the jaw

Background Radiotherapy (RT) is a key component in the multimodal treatment approach for head and neck cancer (HNC). Post-therapeutic surgical and/or dental interventions on the jawbone carry a risk of developing osteoradionecrosis (ORN). To mitigate this risk, dental examinations and, if necessary,...

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Published in:BMC oral health Vol. 25; no. 1; pp. 835 - 10
Main Authors: Schweyen, Ramona, Heinrich, Stephanie, Lückmann, Sara Lena, Hey, Jeremias, Fleischer, Steffen
Format: Journal Article
Language:English
Published: London BioMed Central 28.05.2025
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Adult
Aged
Cancer therapies
Chemotherapy
Chronic obstructive pulmonary disease
Classification
Comorbidity
Complications and side effects
Dental Care - statistics & numerical data
Dental research
Dentistry
Dentists
Diabetes
Diabetes mellitus
Drug abuse
Drug dosages
Female
Head & neck cancer
Head and neck cancer
Head and Neck Neoplasms - radiotherapy
Health insurance
Health service research
Humans
Information management
Insurance, Health - statistics & numerical data
Interdisciplinary aspects
Jaw
Jaw diseases
Jaw Diseases - epidemiology
Jaw Diseases - etiology
Localization
Long term health care
Lung diseases
Male
Medicine
Middle Aged
Oral and Maxillofacial Surgery
Osteoradionecrosis
Osteoradionecrosis - epidemiology
Osteoradionecrosis - etiology
Patients
Physiological aspects
Population studies
Radiation therapy
Radiotherapy
Risk factors
Statistics
Teeth
Therapeutics, Dental
Tooth Extraction - statistics & numerical data
Wound healing
Germany
Head and neck cancer
Health service research
Radiotherapy
Risk factors
Osteoradionecrosis
ISSN:1472-6831, 1472-6831
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Summary:Background Radiotherapy (RT) is a key component in the multimodal treatment approach for head and neck cancer (HNC). Post-therapeutic surgical and/or dental interventions on the jawbone carry a risk of developing osteoradionecrosis (ORN). To mitigate this risk, dental examinations and, if necessary, treatment should be conducted prior to RT. However, the consistent implementation of these recommendations in routine dental practice remains uncertain. This study aimed to evaluate whether insured persons of AOK Saxony-Anhalt (AOK ST) utilise dental services in accordance with current treatment recommendations and whether this behaviour influences the need for post-therapeutic tooth removal and the occurrence of ORN. Methods Anonymised health claims data were analysed from individuals newly diagnosed with HNC between 2017 and 2021, who received RT and were continuously insured by AOK ST from 1 year before the start of RT to 2022. Three dependent variables were evaluated: dental treatment prior to RT, tooth extraction after RT, and ORN occurrence. Independent variables included sex, age, tooth extraction before RT, need for care, exemption from copayment, bisphosphonate prescription, diabetes, chronic obstructive pulmonary disease, alcohol abuse, chemotherapy, and guideline adherence. Results Data from 1,086 patients with HNC diagnoses (75.9% male) were analysed. The median follow-up time from the first RT was 796 days (first quartile: 316 days; third quartile: 1,210 days). Twenty-one patients (1.9%) developed ORN after RT. More than 50% of the study population received dental care in accordance with guideline recommendations prior to RT. Need for care had the most significant negative effect on the utilisation of dental treatment prior to RT. Conclusion This study did not find evidence of consistent implementation of the recommended guidelines for dental assessment/therapy prior to RT. Patients in need for care and those with chronic comorbidities were less likely to receive and/or require dental care. Although no significant influence on ORN development was observed, the reliability of this finding is limited by the small cohort size and low ORN incidence. Further studies with larger cohorts are needed to validate these findings.
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ISSN:1472-6831
1472-6831
DOI:10.1186/s12903-025-06114-y