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

Abstract

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.