Can radiotherapy cause dental pulp necrosis? a systematic review and meta-analysis

Objectives To address whether radiotherapy could induce pulp necrosis in patients with head and neck cancer. Study Design A search was constructed according to patient, intervention, comparision, outcome and studies (PICOS) in the MEDLINE/PubMed, Cochrane Library, EMBASE, Web of Science, Scopus, and Open Grey databases. Clinical studies with pulp status assessment in patients with head and neck cancer subjected to radiotherapy were eligible. Risk of bias was evaluated using risk of bias in non-randomized studies- of interventions (ROBINS-I). RevMan software was used for meta-analysis. Results Out of the 171 potentially relevant records, 5 were included. Pulp status was assessed through cold thermal pulp sensitivity (CTPS), pulse oximetry, and electrical tests. Treatments were mostly radiotherapy alone, with intensity-modulated radiation therapy (IMRT) as the radiation modality (60-70 Gy total dose). All studies reported a significant reduction of CTPS responses in postradiotherapy periods (n = 4, I2 = 0%, P < .00001; n = 3, I2 = 0%, P < .00001). Electrical tests also revealed significant alterations postradiotherapy (n = 2, I2 = 68%, P < .00001). Pulp oxygenation presented no significant differences, yet meta-analysis was not feasible. Overall, 3 studies presented serious risk of bias and 2 presented moderate risk of bias. Conclusions CTPS and electrical tests revealed significant altered response postradiotherapy. However, cautious interpretation is required because they are not absolutely reliable tests, in addition to the quality of evidence presented. To address whether radiotherapy could induce pulp necrosis in patients with head and neck cancer. A search was constructed according to patient, intervention, comparision, outcome and studies (PICOS) in the MEDLINE/PubMed, Cochrane Library, EMBASE, Web of Science, Scopus, and Open Grey databases. Clinical studies with pulp status assessment in patients with head and neck cancer subjected to radiotherapy were eligible. Risk of bias was evaluated using risk of bias in non-randomized studies- of interventions (ROBINS-I). RevMan software was used for meta-analysis. Out of the 171 potentially relevant records, 5 were included. Pulp status was assessed through cold thermal pulp sensitivity (CTPS), pulse oximetry, and electrical tests. Treatments were mostly radiotherapy alone, with intensity-modulated radiation therapy (IMRT) as the radiation modality (60-70 Gy total dose). All studies reported a significant reduction of CTPS responses in postradiotherapy periods (n = 4, I2 = 0%, P < .00001; n = 3, I2 = 0%, P < .00001). Electrical tests also revealed significant alterations postradiotherapy (n = 2, I2 = 68%, P < .00001). Pulp oxygenation presented no significant differences, yet meta-analysis was not feasible. Overall, 3 studies presented serious risk of bias and 2 presented moderate risk of bias. CTPS and electrical tests revealed significant altered response postradiotherapy. However, cautious interpretation is required because they are not absolutely reliable tests, in addition to the quality of evidence presented.