How does dental treatment affect oral health of patients received radiotherapy and bone-modifying agent: systematic review

Abstract Background: Radiotherapy and bone-modifying agents are widely used to treat malignancies and metastases. Bone-modifying agents and radiation-related adverse effects on oral health detrimentally affect dental treatment outcomes. Two common complications occur during and after radiotherapy: bone-modifying medications, osteoradionecrosis, and osteonecrosis of the bones. Dental professionals play an important role in evaluating procedures that can potentially cause these complications. Objective: This systematic review aimed to evaluate the effects of dental treatment on oral health in patients who had received radiotherapy and bone-modifying agents. Methods: A comprehensive search was conducted using PubMed, Scopus, Web of Science, Embase, Medline, Proquest, and Cochrane Library from 2015-2023 following PRISMA guidelines. Results: Eighteen articles, published between 2015 and 2023, were reviewed. Dental implants have been the main focus of attention in most studies, as radiation therapy can reduce the microhardness of enamel and dentin and increase the risk of osteoradionecrosis (ORN) and tooth failure. However, dental implants can still be successful with proper bone quality and implant techniques, and bisphosphonate therapy does not significantly affect implant failure. Conclusion: The risk of developing osteonecrosis was not significant, but was increased by parenteral administration compared with oral administration. Bisphosphate is associated with deep pockets, higher bleeding index, and pulp obliteration.