Conformational and constitutional analysis of dental caries following radiotherapy for head and neck cancer
Abstract
BACKGROUND: This study aimed to investigate the morphology and chemical composition of dental caries related to ionizing radiation (DCIR), an aggressive and progressive disease that affects dental hard tissues.
MATERIALS AND METHODS: Eight human teeth with DCIR were paired with sixteen control teeth (8 teeth with conventional caries and 8 without caries) and included in this study. An analysis of the morphology of the lesions was performed using the following techniques: periapical radiography, cone beam computed tomography, computed microtomography, and scanning electron microscopy. The chemical composition was assessed using X-ray dispersive spectroscopy.
RESULTS: There was more demineralization in DCIR lesions when compared to conventional dental caries, even though there was no cavitation in the cervical region of the teeth. The superficial roughness and topography of DCIR lesions were similar to those of healthy teeth. On the other hand, lesions of conventional dental caries showed greater surface and topographic irregularity when compared to DCIR and healthy teeth (p = 0.001). Calcium (Ca) and phosphorus (P) levels were lower in DCIR lesions when compared to controls. However, higher levels of carbon (C) have been observed in DCIR lesions. There was a greater loss of the mineral matrix in DCIR followed by conventional caries. The reduction in the mineral matrix (Ca and P) was compatible with the imaging patterns observed in teeth with DCIR and conventional caries.
CONCLUSION: Despite their rapid evolution, DCIR presents an irregular, apparently intact surface with significant changes in the amount of Ca, P, and C.
Keywords: dental cariesradiotherapycomputed tomographycomputed microtomographyelectron microscopyspectroscopy
References
- Semrau R. The Role of Radiotherapy in the Definitive and Postoperative Treatment of Advanced Head and Neck Cancer. Oncol Res Treat. 2017; 40(6): 347–352.
- Koh J, Walsh P, D'Costa I, et al. Head and neck squamous cell carcinoma survivorship care. Aust J Gen Pract. 2019; 48(12): 846–848.
- Cho H, Kumar N. Dental management of a patient with head and neck cancer: a case report. Br Dent J. 2019; 227(1): 25–29.
- Strojan P, Hutcheson KA, Eisbruch A, et al. Treatment of late sequelae after radiotherapy for head and neck cancer. Cancer Treat Rev. 2017; 59: 79–92.
- Lalla RV, Treister N, Sollecito T, et al. OraRad Study Group. Oral complications at 6 months after radiation therapy for head and neck cancer. Oral Dis. 2017; 23(8): 1134–1143.
- Høxbroe Michaelsen S, Grønhøj C, Høxbroe Michaelsen J, et al. Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients. Eur J Cancer. 2017; 78: 91–102.
- Kielbassa AM, Schendera A, Schulte-Mönting J. Microradiographic and microscopic studies on in situ induced initial caries in irradiated and nonirradiated dental enamel. Caries Res. 2000; 34(1): 41–47.
- Kielbassa A, Hinkelbein W, Hellwig E, et al. Radiation-related damage to dentition. Lancet Oncol. 2006; 7(4): 326–335.
- Moore C, McLister C, Cardwell C, et al. Dental caries following radiotherapy for head and neck cancer: A systematic review. Oral Oncol. 2020; 100: 104484.
- de Oliveira Mota CC, Gueiros LA, Maia AM, et al. Optical coherence tomography as an auxiliary tool for the screening of radiation-related caries. Photomed Laser Surg. 2013; 31(7): 301–306.
- Morais-Faria K, Neves-Silva R, Lopes MA, et al. The wolf in sheep's clothing: Microtomographic aspects of clinically incipient radiation-related caries. Med Oral Patol Oral Cir Bucal. 2016; 21(3): e299–e304.
- Springer IN, Niehoff P, Warnke PH, et al. Radiation caries--radiogenic destruction of dental collagen. Oral Oncol. 2005; 41(7): 723–728.
- Lieshout HFJ, Bots CP. The effect of radiotherapy on dental hard tissue--a systematic review. Clin Oral Investig. 2014; 18(1): 17–24.
- Silva ARS, Alves FA, Antunes A, et al. Patterns of demineralization and dentin reactions in radiation-related caries. Caries Res. 2009; 43(1): 43–49.
- Arnold WH, Konopka S, Kriwalsky MS, et al. Morphological analysis and chemical content of natural dentin carious lesion zones. Ann Anat. 2003; 185(5): 419–424.
- Arnold WH, Bietau V, Renner PO, et al. Micromorphological and micronanalytical characterization of stagnating and progressing root caries lesions. Arch Oral Biol. 2007; 52(6): 591–597.
- Deng J, Jackson L, Epstein JB, et al. Dental demineralization and caries in patients with head and neck cancer. Oral Oncol. 2015; 51(9): 824–831.
- Gomes-Silva W, Prado-Ribeiro AC, Brandão TB, et al. Postradiation Matrix Metalloproteinase-20 Expression and Its Impact on Dental Micromorphology and Radiation-Related Caries. Caries Res. 2017; 51(3): 216–224.
- Hong CHL, Napeñas JJ, Hodgson BD, et al. Dental Disease Section, Oral Care Study Group, Multi-national Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO). A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer. 2010; 18(8): 1007–1021.
- Sroussi HY, Epstein JB, Bensadoun RJ, et al. Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med. 2017; 6(12): 2918–2931.
- Mathew A, Sara George P, M C K, et al. Cancer Incidence and Mortality: District Cancer Registry, Trivandrum, South India. Asian Pac J Cancer Prev. 2017; 18(6): 1485–1491.
- Dyzmann-Sroka A, Malicki J. Cancer incidence and mortality in the Greater Poland Region-Analysis of the year 2010 and future trends. Rep Pract Oncol Radiother. 2014; 19(5): 296–300.
- de Pauli Paglioni M, Palmier NR, Prado-Ribeiro AC, et al. The impact of radiation caries in the quality of life of head and neck cancer patients. Support Care Cancer. 2020; 28(6): 2977–2984.
- Hobson RS, McCabe JF, Hogg SD. Bond strength to surface enamel for different tooth types. Dent Mater. 2001; 17(2): 184–189.
- Park S, Wang DH, Zhang D, et al. Mechanical properties of human enamel as a function of age and location in the tooth. J Mater Sci Mater Med. 2008; 19(6): 2317–2324.
- Reed R, Xu C, Liu Y, et al. Radiotherapy effect on nano-mechanical properties and chemical composition of enamel and dentine. Arch Oral Biol. 2015; 60(5): 690–697.