{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T02:18:06Z","timestamp":1794536286739,"version":"4.9.1"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T00:00:00Z","timestamp":1634601600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with head and neck cancer (HNC) treated with radiation therapy (RT) are at risk for jaw osteoradionecrosis (ORN), which is largely characterized by the presence of exposed necrotic bone. This report describes the incidence and clinical course of and risk factors for exposed intraoral bone in the multicenter Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad) cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants were evaluated before RT and at 6, 12, 18, and 24 months after RT. Exposed bone was characterized by location, sequestrum formation, and other associated features. The radiation dose to the affected area was determined, and the history of treatment for exposed bone was recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study enrolled 572 participants; 35 (6.1%) were diagnosed with incident exposed bone at 6 (47% of reports), 12 (24%), 18 (20%), and 24 months (8%), with 60% being sequestrum and with 7 cases (20%) persisting for &gt;6 months. The average maximum RT dose to the affected area of exposed bone was 5456 cGy (SD, 1768 cGy); the most frequent associated primary RT sites were the oropharynx (42.9%) and oral cavity (31.4%), and 76% of episodes occurred in the mandible. The diagnosis of ORN was confirmed in 18 participants for an incidence rate of 3.1% (18 of 572). Risk factors included pre\u2010RT extractions (<jats:italic>P<\/jats:italic> = .008), a higher RT dose (<jats:italic>P<\/jats:italic> = .039), and tobacco use (<jats:italic>P<\/jats:italic> = .048).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The 2\u2010year incidence of exposed bone in the OraRad cohort was 6.1%; the incidence of confirmed ORN was 3.1%. Exposed bone after RT for HNC is relatively uncommon and, in most cases, is a short\u2010term complication, not a recurring or persistent one.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.33948","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T22:41:48Z","timestamp":1634769708000},"page":"487-496","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Exposed bone in patients with head and neck cancer treated with radiation therapy: An analysis of the Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad)"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5596-7222","authenticated-orcid":false,"given":"Nathaniel S.","family":"Treister","sequence":"first","affiliation":[{"name":"Division of Oral Medicine and Dentistry Brigham and Women's Hospital Boston Massachusetts"},{"name":"Department of Oral Medicine, Infection, and Immunity Harvard School of Dental Medicine Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Brennan","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine Atrium Health's Carolinas Medical Center Charlotte North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas P.","family":"Sollecito","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine University of Pennsylvania School of Dental Medicine Philadelphia Pennsylvania"},{"name":"Division of Oral Medicine University of Pennsylvania Health System Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian L.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery and Bluestone Center for Clinical Research New York University College of Dentistry New York New 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Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania Health System Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6051-7413","authenticated-orcid":false,"given":"Ryann","family":"Shadick","sequence":"additional","affiliation":[{"name":"Division of Oral Medicine and Dentistry Brigham and Women's Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Hodges","sequence":"additional","affiliation":[{"name":"Division of Biostatistics School of Public Health University of Minnesota Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh V.","family":"Lalla","sequence":"additional","affiliation":[{"name":"Section of Oral Medicine University of Connecticut Health 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