Occurrence of Jaw Osteonecrosis and Frequency of Prophylactic Tooth Extractions Prior to Head and Neck Radiotherapy: A Retrospective Study of 497 Irradiated Patients

<b>Background/Objectives:</b> This retrospective study examined the relationship between prophylactic tooth extraction (PTE) and the occurrence of jaw osteoradionecrosis (JORN) in patients undergoing head and neck radiotherapy (HNR). The primary objective was to determine whether PTE resulted in a JORN rate comparable to that of patients who did not require or undergo PTE. <b>Methods:</b> A total of 497 patients were included. The primary predictor variable was PTE, and the primary outcome was JORN occurrence. Statistical analyses included univariate, bivariate, and multivariate regression, as well as Cox regression. The significance threshold was set at <i>p</i> ≤ 0.005. <b>Results:</b> JORN was more frequent in the PTE group than in patients who did not require or undergo PTE (17.1% vs. 13.0%; hazard ratio [HR] 1.71, 95% CI: 1.08-2.71, <i>p</i> = 0.021). However, a significant association could not be confirmed using multiple logistic regression (odds ratio [OR] 1.36, 95% CI: 0.82-2.26, <i>p</i> = 0.236). Suggestive associations were observed for HNR dose (HR 1.03 per Gy, <i>p</i> = 0.007) and tumor location (pharyngeal HR 0.52, <i>p</i> = 0.03; laryngeal HR 0.51, <i>p</i> = 0.02). <b>Conclusions:</b> Patients with PTE showed a higher JORN rate but the findings were only marginally significant, and no causal relationship was established. The differing results between Cox and logistic regression suggest a time-dependent effect of PTE, with an increased early risk for JORN. Further studies are needed to determine whether greater emphasis should be placed on tooth-preserving measures, limiting extractions before HNR to strictly non-preservable teeth.