{"entity":{"id":"idea-pu-dental-extraction-healing-interval","kind":"idea","name":"Settling the minimum gap between dental extraction and the start of head and neck radiotherapy","aka":[],"tldr":"Teeth that might cause trouble are often taken out before radiotherapy to the jaw, to lower the risk of the bone breaking down later. How long the sockets should heal before radiotherapy starts is not settled: waiting longer may help the jaw but delays cancer treatment, and the studies so far disagree.","summary":"The evidence. A 2026 meta-analysis of eight retrospective cohorts (47,527 people with head and neck cancer, 2,863 cases of osteoradionecrosis) found no overall association between the extraction-to-radiotherapy interval and osteoradionecrosis (odds ratio 0.99, 95 per cent confidence interval 0.67 to 1.47), with very high heterogeneity (I² 92 per cent). In Western populations, starting radiotherapy within 7 days of extraction was associated with higher risk (odds ratio 3.07, 1.52 to 6.21), as was starting within 14 days (2.01, 1.10 to 3.68). A 2022 meta-analysis of seven studies (875 people treated with IMRT) found that extractions before IMRT were associated with less osteoradionecrosis than extractions after, but the prediction interval included no effect and the authors concluded the benefit was not proven, to be balanced against delay to cancer treatment.\n\nThe guideline. The ISOO-MASCC-ASCO guideline on osteoradionecrosis (2024) is the current international standard; only its abstract could be read for this record, so whether it states an interval is not reported here.\n\nWhat is unknown. Every study is retrospective and none randomises the interval; how much delay to radiotherapy is acceptable for a given tumour is a separate question the dental studies do not address.","asOf":"2026-11-11","links":[{"label":"Timing for radiotherapy initiation after dental extraction and risk of osteoradionecrosis in head and neck cancer patients: a systematic review and meta-analysis (World Journal of Otorhinolaryngology - Head and Neck Surgery 2026)","url":"https://doi.org/10.1002/wjo2.70097"},{"label":"Balermpas et al., Dental extraction, intensity-modulated radiotherapy of head and neck cancer, and osteoradionecrosis: a systematic review and meta-analysis (Strahlentherapie und Onkologie 2022)","url":"https://doi.org/10.1007/s00066-021-01896-w"},{"label":"Peterson et al., Prevention and management of osteoradionecrosis in patients with head and neck cancer treated with radiation therapy: ISOO-MASCC-ASCO guideline (Journal of Clinical Oncology 2024)","url":"https://doi.org/10.1200/jco.23.02750"}],"tags":["protocol-upgrade","upgrade:untested","evidence:insufficient"],"related":[],"cancers":["head-and-neck","oral-cavity-cancer","oropharyngeal-cancer"],"sections":["supportive-care","radiation"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["mascc","asco"],"pathways":[],"terms":["late-effects"],"trials":[],"people":[],"bottlenecks":["b-toxicity-qol","b-survivorship"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A minimum healing interval of about two weeks between extraction and radiotherapy lowers osteoradionecrosis without worsening tumour control, compared with starting radiotherapy as soon as planning allows.","rationale":"The pooled subgroup signal in Western cohorts points at the first one to two weeks, the overall analysis does not, and the decision is made for thousands of people a year with delay to cancer treatment on the other side of the scale.","test":"A prospective multicentre cohort with interval recorded to the day, dental dose and osteoradionecrosis at two years, nested in pathways that already time planning around dental clearance; a randomised comparison of a short and a longer interval if equipoise is confirmed.","maturity":"early-clinical","actor":"research","cost":"medium","horizonYears":5},"route":"/ideas/idea-pu-dental-extraction-healing-interval/","neighbours":{"cancer":[{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"oral-cavity-cancer","kind":"cancer","name":"Oral cavity cancer (mouth and tongue)","route":"/cancers/oral-cavity-cancer/"},{"id":"oropharyngeal-cancer","kind":"cancer","name":"Oropharyngeal cancer (tonsil and base of tongue)","route":"/cancers/oropharyngeal-cancer/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"institution":[{"id":"asco","kind":"institution","name":"American Society of Clinical Oncology (ASCO)","route":"/institutions/asco/"},{"id":"mascc","kind":"institution","name":"Multinational Association of Supportive Care in Cancer","route":"/institutions/mascc/"}],"term":[{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"protocol":[{"id":"head-and-neck-radiotherapy-dental-assessment-osteoradionecrosis","kind":"protocol","name":"Dental assessment before head and neck radiotherapy and osteoradionecrosis prevention","route":"/protocols/head-and-neck-radiotherapy-dental-assessment-osteoradionecrosis/"}]}}