Head and neck radiotherapy effects on the dental pulp vitality and response to sensitivity tests: A systematic review with meta-analysis

Abstract

Background: Experimental studies are controversial regarding the effects of radiotherapy for head and neck cancer (HNC) on the dental pulp. Therefore, a systematic review of clinical studies is necessary to investigate whether alterations in pulp status occur. Objectives: To evaluate the evidence on radiotherapy for HNC and pulp status. Methods: A systematic search of articles published until November 2021 was performed in the MEDLINE/PubMed, Cochrane Library, Web of Science (All Databases), Scopus, EMBASE, and Open Grey databases. The eligibility criteria were based on the PICOS strategy, as follows: (P) vital teeth of adult patients with intraoral and/or oropharyngeal cancer; (I) radiotherapy; (C) control group or values of the same tooth before radiotherapy (basal values); (O) pulpal status after radiotherapy; and (S) clinical studies. The Cochrane Risk of Bias in Nonrandomized Studies of Interventions tool was used to assess the quality of the included studies. Meta-analyses were performed using fixed and random effects. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Results: Six studies were included for qualitative analysis. Five were classified as serious risk of bias and one as moderate risk of bias. Four studies reported altered pulp responses to cold thermal tests after radiotherapy initiation. Meta-analyses were performed using three included studies. From these, all were included in the meta-analysis for pulp response values to cold sensitivity test immediately after radiotherapy initiation (risk ratio: 0.00 [CI: 0.00, 0.02], p