Evidence-based management strategies for tooth extractions in oncologic patients: a narrative review of the literature

Abstract

Aim: This narrative review aims to critically evaluate the current evidence regarding managing dental extractions in oncologic patients. Special focus is placed on preventive, therapeutic, and palliative extractions concerning the risks associated with antineoplastic therapies and the absence of standardized clinical protocols.

Materials and Methods: An extensive literature search was conducted using MEDLINE via PubMed, Web of Science, and Scopus databases. The search strategy included a combination of controlled vocabulary and free-text terms related to “oncologic patients,” “tooth extraction,” “osteonecrosis,” and “palliative care.” Studies involving human subjects and written in English were included. The review incorporated randomized controlled trials, cohort studies, case series, clinical guidelines, and systematic or narrative reviews published without date restriction, with special emphasis on research from the last fifteen years.

Results: The analysis showed that preventive extractions before starting chemotherapy or radiotherapy significantly lower the risk of severe complications like MRONJ and osteoradionecrosis. However, overly aggressive extraction protocols may harm oral function and aesthetics, especially when removing more than eight teeth. Therapeutic extractions during cancer treatment need personalized protocols considering immunosuppression, coagulation status, and pharmacologic risk factors. In palliative care, dental extractions help relieve pain, restore basic oral function, and increase patient comfort. Still, conservative options should be considered for high-risk patients.

Conclusion: Tooth extractions in oncologic patients require personalized clinical judgment, multidisciplinary planning, and minimally invasive strategies. Preventive extractions remain essential, but they must be balanced against quality-of-life considerations. Urgently needed are prospective, multicenter clinical studies to establish standardized, evidence-based protocols for dental extractions in cancer care settings.