Top

Clinical Oral Investigations

Published in:

01-01-2014 | Review

The effect of radiotherapy on dental hard tissue—a systematic review

Authors: H. F. J. Lieshout, C. P. Bots

Published in: Clinical Oral Investigations | Issue 1/2014

Abstract

Introduction

Decay of teeth, erosion and disintegration of hard dental tissue are a clinically often seen side effect after radiotherapy for tumours in the head and neck region. To investigate if these side effects are due to structural changes in dental hard tissues, the current literature was searched. It can influence the quality of life gravely.

Method

A systematic PubMed (Medline) search was done and of the 374 hits, 11 articles were included. During the reading of these articles, 10 additional useful references to other articles were retrieved. An extra search was done on “A.M. Kielbassa”, a key writer in many articles on this subject. Four extra articles were found. So in total, 25 articles were analysed in this systematic review.

Results

Tooth destruction occurs often and soon after irradiation. There is no difference between decay in irradiated and non-irradiated teeth. The locations and the progressiveness of the destruction are different in irradiated then in non-irradiated teeth. Several studies show changes in the structure and micro hardness of enamel, the dentinoenamel junction (DEJ) and dentin. The biomechanical properties are dramatically decreased. The odds of moderate/severe tooth damage increased with the irradiation dose.

Conclusion

In conclusion the results of this systematic review show a great amount of changes and damages at all levels of the hard dental tissues, enamel, DEJ and dentin. These findings substantiate the idea that the formation of recurrent and atypical patterns of dental caries in irradiated teeth is, not only due to loss of saliva but a combination of both hyposalivation and the direct effects on hard dental tissue. The formation of atypical caries is furthermore increased due to poor oral hygiene, the increase of soft and carbohydrate-rich substance and changes of the bacterial micro flora and proteins.

Clinical relevance

This article is written to understand more about the cause of destruction of teeth after radiotherapy. This way, a more adequate preventive and restorative treatment plan can be drawn up for an individual patient.

Anneroth G, Holm LE, Karlsson G (1985) The effect of radiation to the teeth. Int J Oral Surg 14:269–274PubMedCrossRef

Al-Nawas B, Grötz KA, Rose E, Duschner H, Kann P, Wagner W (2000) Using ultrasound transmission velocity to analyse the mechanical properties of teeth after in vivo, in situ and in vivo irradiation. Clin Oral Invest 4:168–172CrossRef

Fränzel W, Gerlach R, Hein HJ, Schaller HG (2006) Effect of tumour therapeutic irradiation on the mechanical properties of teeth tissue. Z Med Phys 16:148–154PubMed

Fränzel W, Gerlach R (2009) The irradiation action on human dental tissue by X-rays and electrons a nanoindenter study. Z Med Phys 19:5–10PubMedCrossRef

Gernhardt CR, Kielbassa AM, Hahn P, Schaller HG (2001) Tensile bond strengths of four different dentin adhesives on irradiated and non-irradiated human dentin in vitro. J Oral Rehab 28:814–820CrossRef

Grötz KA, Duschner H, Kutzner J, Thelen M, Wagner W (1997) New evidence for the etiology of the so-called radiation caries. Proof for direct radiogenic damage of the dento-enamel junction. Strahlenther Onkol 173:668–676PubMedCrossRef

Grötz KA, Duschner H, Kutzner J, Thelen M, Wagner W (1998) Histographic study of the direct effects of radiation on dental enamel. Mund Kiefer GesichtsChir 2:85–90PubMedCrossRef

Jansma J, Vissink A, Jongebloed W, Retief H, ‘s Gravenmade EJ (1993) Natural and induced radiation caries: a SEM study. Am J Dent 6(3):130–136PubMed

Joyston-Bechal S (1985) The effect of X-radiation on the susceptibility of enamel to an artificial caries-like attack in vitro. J Dent 3:41–44CrossRef

10.

Kielbassa AM, Beetz I, Schendera A, Hellwig E (1997) Irradiation effects on micro hardness of fluoridated and non-fluoridated bovine dentin. Eur J Oral Sci 105:444–447PubMedCrossRef

11.

Kielbassa AM, Wrbas KT, Schulte-Mönting J, Hellwig E (1999) Correlation of transversal microradiography and microhardness on in situ-induced demineralization in irradiated and nonirradiated human dental enamel. Arch Oral Biol 44:243–251PubMedCrossRef

12.

Kielbassa AM, Wrbas K-T, Dornfeld B, Hellwig E, Schade-Brittinger C (1999) Zum Einfluss der tumortherapeutischen Bestrahlung auf die Kariesentstehung in menschlichem Dentin- Eine In vitro und In situ Untersuchung. Dtsch Zahnärztl Z 54:31–37

13.

Kielbassa AM, Schendera A, Schulte-Monting J (2000) Microradiographic and microscopic studies on in situ induced initial caries in irradiated and non-irradiated dental enamel. Caries Res 34:41–47PubMedCrossRef

14.

Kielbassa AM (2000) In situ induced demineralization in irradiated and non-irradiated human dentin. Eur J Oral Sci 108:214–221PubMedCrossRef

15.

Kielbassa AM, Muntz I, Bruggmoser G, Schulte-Monting J (2002) Effect of demineralization and remineralization on microhardness of irradiated dentin. J Clin Dent 13:104–110PubMed

16.

Kielbassa AM, Hellwig E, Meyer-Lückel H (2006) Effects of irradiation on in situ remineralization of human and bovine enamel demineralised in vitro. Caries Res 40:130–135PubMedCrossRef

17.

Knychalska-Karwan Z, Pawlincki R, Karwan T (1988) Structural and micronanalytical changes in dentition after radiotherapy applied in cases of tumour in the oral cavity region. Folia Histochem Cytobiol 26:25–32PubMed

18.

Pioch T, Golfels D, Staehle HJ (1992) An experimental study of the stability of irradiated teeth in the region of the dento-enamel junction. Endod Dent Traumatol 8:241–244PubMedCrossRef

19.

Silva ARS, Alves FA, Antunes A, Goes MF, Lopes MA (2009) Patterns of demineralization and dentin reactions in radiation-related caries. Caries Res 43:43–49PubMedCrossRef

20.

Soares CJ, Castro CG, Neiva NA, Soares PV, Santos-Filho PCF, Naves LZ, Pereira PNR (2010) Effect of gamma irradiation on ultimate tensile strength of enamel and dentin. J Dent Res 89(2):159–164PubMedCrossRef

21.

Soares CJ, Roscoe MG, Castro CG, Santana FR, Raposo LHA, Quagliatto PS, Novaris VR (2011) Effect of gamma irradiation and restorative material on the biomechanical behaviour of root filled premolars. Int Endod J 44:1047–1054PubMedCrossRef

22.

Springer IN, Niehoff P, Warnke P, Böcek G, Kovács G, Suhr M, Wiltfang J, Açil Y (2005) Radiation caries—radiogenic destruction of dental collagen. Oral Oncol 41:723–728PubMedCrossRef

23.

Vissink A, Jansma J, Spijkervet FKL, Burlage FR, Coppes RP (2003) Orale sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 14(3):199–212PubMedCrossRef

24.

Walker MP, Wichman B, Cheng AL, Coster J, Williams KB (2001) Impact of radiotherapy dose on dentition breakdown in head and neck cancer patients, author manuscript. Pract Radiat Oncol 1(3):142–148CrossRef

25.

Wöstmann B, Rasche KR (1995) The influence of radiotherapy on survival time of teeth and restorations. A study on patients with maxillofacial defects. Zahnärztliche Welt 104:627–627

26.

Burlage FR, Coppes RP, Meertens H, Stokman MA, Vissink A (2001) Parotid and submandibular/sublingual flow during high dose radiotherapy. Radiother Oncol 61:271–274PubMedCrossRef

27.

Dirix P, Nuyts S, van der Poorten V, Delaere P, van den Bogaert W (2008) The influence of xerostomia after radiotherapy on quality of live. Support Care Cancer 16:171–179PubMedCrossRef

28.

Eisbruch A, ten Haken RK, Kim HM, Marsh LH, Ship JA (1999) Dose, volume and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 45:577–587PubMedCrossRef

29.

Fox RI (2005) Sjögren's syndrome. Lancet 366(9482):321–331PubMedCrossRef

30.

Jham BC, da AR SF (2006) Oral complications of radiotherapy in the head and neck. Rev Bras Otorrinolaringol 72(5):704–708CrossRef

31.

Jonhston M, Clifford S, Bromley R, Back M, Oliver L, Eade T (2011) Volumetric-modulated arc therapy in head and neck radiotherapy: a planning comparison using simultaneous integrated boost for nasopharynx and oropharynx carcinoma. Clin Oncol 2:503–5011

32.

Kielbassa AM, Hinkelbein W, Hellwig E, Meyer-Lückel H (2006) Radiat-relat Damage Dentition Lancet Oncol 7:326–335CrossRef

33.

Nagler RM (2002) The enigmatic mechanism of irradiation-induced damage to the major salivary glands. Oral Dis 8:141–146PubMedCrossRef

34.

Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C, Miles EA, Miah AB, Newbold K, Tanay MA, Adab F, Jefferies SJ, Scrase C, Yap BK, A'hern RP, Sydenham MA, Emson M, Hall E (2011) Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12(2):127–136PubMedCentralPubMedCrossRef

35.

Roesink JM, Moerland MA, Battermann JJ, Hordijk GJ, Terhaard CH (2001) Quantitative dose-volume response analysis of changes in parotid gland function after radiotherapy in the head-and-neck region. Int J Radiat Oncol Biol Phys 51:938–946PubMedCrossRef

36.

Seikaly H, Jha N, Harris R, Barnaby P, Liu R, Williams D, McGraw T, Rieger J, Wolfaardt J, Hanson J (2004) Long-term outcomes of submandibular gland transfer for prevention of postradiation xerostomia. Arch Otolaryngol head Neck Surg 130:956–961PubMedCrossRef

37.

Beumer J, Curtis ThA, Marunick MT (1996) Maxillofacial rehabilitation, prosthodontic and surgical considerations, 1st edn. Medico Dental Media International, ‪pp. 43–71

Title: The effect of radiotherapy on dental hard tissue—a systematic review
Authors: H. F. J. Lieshout
C. P. Bots
Publication date: 01-01-2014
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 1/2014
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-013-1034-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effect of radiotherapy on dental hard tissue—a systematic review

Abstract

Introduction

Method

Results

Conclusion

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Method

Results

Conclusion

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 1/2014

The relationship between implant stability and bone health markers in post-menopausal women with bisphosphonate exposure

Comments about the paper “Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial”

Oral squamous cell carcinoma in the vicinity of dental implants

Response to a letter to the Editor addressing the publication “Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial”

Comparison of intraoral radiography and cone-beam computed tomography for the detection of horizontal root fractures: an in vitro study

Desmoglein-3/γ-catenin and E-cadherin/ß-catenin differential expression in oral leukoplakia and squamous cell carcinoma