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The impact of timing and modalities of dental prophylaxis on the risk of 5-fluorouracil–related oral mucositis in patients with head and neck cancer: a nationwide population-based cohort study

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Abstract

Purpose

This study investigated the impact of dental prophylaxis on 5-fluorouracil (5-FU)–related oral mucositis (OM) according to the head and neck cancer (HNC) locations and treatment times.

Methods

A total of 13,969 HNC participants, including 482 5-FU–related OM subjects and 13,487 comparisons were enrolled from the Longitudinal Health Insurance Database for Catastrophic Illness Patients of Taiwan between 2000 and 2008. All subjects were stratified into subgroups based on the times to perform chlorhexidine use, scaling, and fluoride application before 5-FU administration. The dental prophylaxis related to 5-FU–related OM was estimated by multiple logistic regression and represented with odds ratio (OR) and 95% confidence interval (CI).

Results

Fluoride gel application and scaling significantly impacted on OM development (p < 0.001), and the joint effect of fluoride gel and scaling induced 5-FU–related OM (OR = 3.46, 95% CI = 2.39–5.01). The risk of OM was raised 2.25-fold as scaling within 3 weeks before 5-FU–related chemotherapy (95% CI = 1.81–2.81), and a 3.22-fold increased risk of OM while fluoride gel was applied during 5-FU–related treatment (95% CI = 1.46–7.13).

Conclusion

Dental prophylaxis significantly affected 5-FU–related OM in the HNC population. A short interval between dental scaling or fluoride application and 5-FU administration may be associated with higher prevalence of OM. Scaling simultaneously combined with chlorohexidine promoted 5-FU–related OM in specific HNC patients excluding the oral cancer and nasopharyngeal cancer population. Proper timing of the prophylactic dental treatments prior to 5-FU therapy could reduce the risk to develop 5-FU–related OM.

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Funding

This study is supported in part by the Ministry of Health and Welfare, Taiwan (MOHW109-TDU-B-212-114004), MOST Clinical Trial Consortium for Stroke (MOST 109-2321-B-039-002), China Medical University Hospital (DMR-108-103), Chang Gung Memorial Hospital CMRPG3J1801,CMRPG3H1671, CMRPG3G0301, CMRPG3I0151, and CMRPG3E1341), Taiwan, Far Eastern Memorial Hospital (FEMH-2019-C-039), and Tseng-Lien Lin Foundation, Taichung, Taiwan.

Author information

Authors and Affiliations

  1. Department of General Dentistry, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan

    Yi-Fang Huang & Cheng-Chang Chen

  2. School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan

    Yi-Fang Huang & Chung-Ta Chang

  3. Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan

    Yi-Fang Huang, Yu-Fang Liao & Hsiang-Hsi Hong

  4. Center for Translational Medicine, China Medical University and Hospital, Taichung, 40402, Taiwan

    Shih-Ping Liu

  5. Program for Aging, College of Medicine, China Medical University, Taichung, 40402, Taiwan

    Shih-Ping Liu

  6. Department of Social Work, Asia University, Taichung, 41354, Taiwan

    Shih-Ping Liu

  7. Management Office for Health Data, China Medical University Hospital, Taichung, 40402, Taiwan

    Chih-Hsin Muo & Hsuan-Ju Chen

  8. Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, 10507, Taiwan

    Yu-Fang Liao

  9. Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, 33378, Taiwan

    Yu-Fang Liao

  10. Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan

    Yu-Fang Liao

  11. Division of Cardiovascular Surgery, Cardiovascular Center, Far-Eastern Memorial Hospital, New Taipei, 22056, Taiwan

    Kuan-Ming Chiu

  12. Department of Nursing, Oriental Institute of Technology, New Taipei, 22056, Taiwan

    Kuan-Ming Chiu

  13. Department of Electrical Engineering, Yuan Ze University, Taoyuan, 32003, Taiwan

    Kuan-Ming Chiu

  14. Department of Orthopedics, China Medical University Hospital, Taichung, 40402, Taiwan

    Chun-Hao Tsai

  15. Graduate Institute of Clinical Medicine, China Medical University, Taichung, 40402, Taiwan

    Chun-Hao Tsai

  16. Department of Periodontology, Chang Gung Memorial Hospital, Linkou No. 5, Fuxing St., Guishan District, Taoyuan City, 33305, Taiwan

    Hsiang-Hsi Hong

  17. Department of Emergency Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 22056, Taiwan

    Chung-Ta Chang

Authors
  1. Yi-Fang Huang
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  2. Shih-Ping Liu
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  3. Chih-Hsin Muo
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  4. Hsuan-Ju Chen
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  5. Yu-Fang Liao
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  6. Kuan-Ming Chiu
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  7. Cheng-Chang Chen
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  8. Chun-Hao Tsai
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  9. Hsiang-Hsi Hong
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  10. Chung-Ta Chang
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Contributions

Y.F. Huang contributed to conception, design, and data interpretation and drafted the manuscript; S.P. Liu contributed to data acquisition and analysis and drafted the manuscript; C.H. Muo contributed to data acquisition and analysis and drafted the manuscript; H.J. Chen contributed to data acquisition and drafted the manuscript; Y.F Liao and C.C. Chen contributed to data acquisition and drafted the manuscript; K.M. Chiu and C.H. Tsai contributed to data interpretation and critically revised the manuscript; H.H. Hong contributed to conception, design, and data interpretation and critically revised the manuscript; C.T. Chang, contributed to conception, design, data interpretation, and critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Hsiang-Hsi Hong or Chung-Ta Chang.

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Huang, YF., Liu, SP., Muo, CH. et al. The impact of timing and modalities of dental prophylaxis on the risk of 5-fluorouracil–related oral mucositis in patients with head and neck cancer: a nationwide population-based cohort study. Support Care Cancer 29, 3163–3171 (2021). https://doi.org/10.1007/s00520-020-05825-y

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