Skip to main content
Top
Published in: Radiation Oncology 1/2019

Open Access 01-12-2019 | Radiation Caries | Research

Direct radiation-induced effects on dental hard tissue

Authors: Hui Lu, Qi Zhao, Jiang Guo, Binghui Zeng, Xinlin Yu, Dongsheng Yu, Wei Zhao

Published in: Radiation Oncology | Issue 1/2019

Login to get access

Abstract

Background

Radiation caries is a complication of radiotherapy characterized by enamel erosion and dentin exposure. The mechanisms of characteristic radiation caries formation are not well-understood. The aim of this study was to evaluate the direct radiation-induced effects on dental hard tissue and investigate their role in the formation of radiation caries.

Methods

Sixty non-carious third molars were divided into three groups (n = 20), which would be exposed to 0 Gy, 30 Gy, and 60 Gy radiation, respectively. After radiation, microhardness and elastic modulus were measured at four depths by means of a Vickers microhardness tester and atomic force microscopy (AFM). The microstructure was observed by scanning electron microscopy (SEM). X-ray diffraction and Raman microspectroscopy were used to determine crystal properties and protein/mineral (2931/960 cm− 1) ratios.

Results

A statistically significant decrease in microhardness and elastic modulus values 50 μm from the dentino-enamel junction (DEJ) in enamel was revealed in the 30-Gy and 60-Gy groups. With the increasing dose, destruction of interprismatic substance and fissures at the DEJ-adjacent region were found. A greater reduction of crystallinity was revealed in enamel compared with dentin. Raman spectroscopic analysis showed a slight increase of the protein/mineral ratio for enamel following accumulated radiation, while the protein/mineral ratio for dentin was decreased.

Conclusions

Radiation could directly alter the mechanical properties, micro-morphology, crystal properties, and chemical composition of dental hard tissue. The early destruction of DEJ-adjacent enamel, combined with decreased crystallinity of enamel under radiation exposure, may be related to the formation of characteristic radiation caries.
Literature
1.
go back to reference Hong CH, Napenas JJ, Hodgson BD, Stokman MA, Mathers-Stauffer V, Elting LS, Spijkervet FK, Brennan MT. Dental disease section OCSGM-nAoSCiCISoOO. A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer. 2010;18(8):1007–21.CrossRef Hong CH, Napenas JJ, Hodgson BD, Stokman MA, Mathers-Stauffer V, Elting LS, Spijkervet FK, Brennan MT. Dental disease section OCSGM-nAoSCiCISoOO. A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer. 2010;18(8):1007–21.CrossRef
2.
go back to reference McMillan AS, Pow EH, Leung WK, Wong MC, Kwong DL. Oral health-related quality of life in southern Chinese following radiotherapy for nasopharyngeal carcinoma. J Oral Rehabil. 2004;31(6):600–8.CrossRef McMillan AS, Pow EH, Leung WK, Wong MC, Kwong DL. Oral health-related quality of life in southern Chinese following radiotherapy for nasopharyngeal carcinoma. J Oral Rehabil. 2004;31(6):600–8.CrossRef
3.
go back to reference Niewald M, Fleckenstein J, Mang K, Holtmann H, Spitzer WJ, Rube C. Dental status, dental rehabilitation procedures, demographic and oncological data as potential risk factors for infected osteoradionecrosis of the lower jaw after radiotherapy for oral neoplasms: a retrospective evaluation. Radiat Oncol. 2013;8:227.CrossRef Niewald M, Fleckenstein J, Mang K, Holtmann H, Spitzer WJ, Rube C. Dental status, dental rehabilitation procedures, demographic and oncological data as potential risk factors for infected osteoradionecrosis of the lower jaw after radiotherapy for oral neoplasms: a retrospective evaluation. Radiat Oncol. 2013;8:227.CrossRef
4.
go back to reference Kielbassa AM, Hinkelbein W, Hellwig E, Meyer-Lückel H. Radiation-related damage to dentition. Lancet Oncol. 2006;7(4):326–35.CrossRef Kielbassa AM, Hinkelbein W, Hellwig E, Meyer-Lückel H. Radiation-related damage to dentition. Lancet Oncol. 2006;7(4):326–35.CrossRef
5.
go back to reference Silva AR, Alves FA, Berger SB, Giannini M, Goes MF, Lopes MA. Radiation-related caries and early restoration failure in head and neck cancer patients. A polarized light microscopy and scanning electron microscopy study. Support Care Cancer. 2010;18(1):83–7.CrossRef Silva AR, Alves FA, Berger SB, Giannini M, Goes MF, Lopes MA. Radiation-related caries and early restoration failure in head and neck cancer patients. A polarized light microscopy and scanning electron microscopy study. Support Care Cancer. 2010;18(1):83–7.CrossRef
6.
go back to reference Silva AR, Alves FA, Antuñes A, Goes MF, Lopes MA. Patterns of demineralization and dentin reactions in radiation-related caries. Caries Res. 2009;43(1):43–9.CrossRef Silva AR, Alves FA, Antuñes A, Goes MF, Lopes MA. Patterns of demineralization and dentin reactions in radiation-related caries. Caries Res. 2009;43(1):43–9.CrossRef
7.
go back to reference Walker MP, Wichman B, Cheng AL, Coster J, Williams KB. Impact of radiotherapy dose on dentition breakdown in head and neck cancer patients. Pract Radiat Oncol. 2011;1(3):142–8.CrossRef Walker MP, Wichman B, Cheng AL, Coster J, Williams KB. Impact of radiotherapy dose on dentition breakdown in head and neck cancer patients. Pract Radiat Oncol. 2011;1(3):142–8.CrossRef
8.
go back to reference Grundmann O, Mitchell GC, Limesand KH. Sensitivity of salivary glands to radiation: from animal models to therapies. J Dent Res. 2009;88(10):894–903.CrossRef Grundmann O, Mitchell GC, Limesand KH. Sensitivity of salivary glands to radiation: from animal models to therapies. J Dent Res. 2009;88(10):894–903.CrossRef
9.
go back to reference Schweyen R, Hey J, Franzel W, Vordermark D, Hildebrandt G, Kuhnt T. Radiation-related caries: etiology and possible preventive strategies. What should the radiotherapist know? Strahlenther Onkol. 2012;188(1):21–8 (in German).CrossRef Schweyen R, Hey J, Franzel W, Vordermark D, Hildebrandt G, Kuhnt T. Radiation-related caries: etiology and possible preventive strategies. What should the radiotherapist know? Strahlenther Onkol. 2012;188(1):21–8 (in German).CrossRef
10.
go back to reference Gonçalves LM, Palma-Dibb RG, Paula-Silva FW, Oliveira HF, Nelson-Filho P, Silva LA, Queiroz AM. Radiation therapy alters microhardness and microstructure of enamel and dentin of permanent human teeth. J Dent. 2014;42(8):986–92.CrossRef Gonçalves LM, Palma-Dibb RG, Paula-Silva FW, Oliveira HF, Nelson-Filho P, Silva LA, Queiroz AM. Radiation therapy alters microhardness and microstructure of enamel and dentin of permanent human teeth. J Dent. 2014;42(8):986–92.CrossRef
11.
go back to reference Lieshout HF, Bots CP. The effect of radiotherapy on dental hard tissue—a systematic review. Clin Oral Investig. 2014;18(1):17–24.CrossRef Lieshout HF, Bots CP. The effect of radiotherapy on dental hard tissue—a systematic review. Clin Oral Investig. 2014;18(1):17–24.CrossRef
12.
go back to reference de Siqueira MT, Palma-Dibb RG, de Oliveira HF, Garcia Paula-Silva FW, Nelson-Filho P, da Silva RA, da Silva LA, de Queiroz AM. The effect of radiation therapy on the mechanical and morphological properties of the enamel and dentin of deciduous teeth—an in vitro study. Radiat Oncol. 2014;9:30.CrossRef de Siqueira MT, Palma-Dibb RG, de Oliveira HF, Garcia Paula-Silva FW, Nelson-Filho P, da Silva RA, da Silva LA, de Queiroz AM. The effect of radiation therapy on the mechanical and morphological properties of the enamel and dentin of deciduous teeth—an in vitro study. Radiat Oncol. 2014;9:30.CrossRef
13.
go back to reference Oliver WC, Pharr GM. An improved technique for determining hardness and elastic modulus using load and displacement sensing indentation experiments. J Mater Res. 1992;7:1564–83.CrossRef Oliver WC, Pharr GM. An improved technique for determining hardness and elastic modulus using load and displacement sensing indentation experiments. J Mater Res. 1992;7:1564–83.CrossRef
14.
go back to reference Qing P, Huang S, Gao S, Qian L, Yu H. Effect of gamma irradiation on the wear behaviour of human tooth enamel. Sci Rep. 2015;5:11568.CrossRef Qing P, Huang S, Gao S, Qian L, Yu H. Effect of gamma irradiation on the wear behaviour of human tooth enamel. Sci Rep. 2015;5:11568.CrossRef
15.
go back to reference Lee N, Xia P, Quivey JM, Sultanem K, Poon I, Akazawa C, Akazawa P, Weinberg V, Fu KK. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys. 2002;53(1):12–22.CrossRef Lee N, Xia P, Quivey JM, Sultanem K, Poon I, Akazawa C, Akazawa P, Weinberg V, Fu KK. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys. 2002;53(1):12–22.CrossRef
16.
go back to reference Andrews N, Griffiths C. Dental complications of head and neck radiotherapy: part 1. Aust Dent J. 2001;46(2):88–94.CrossRef Andrews N, Griffiths C. Dental complications of head and neck radiotherapy: part 1. Aust Dent J. 2001;46(2):88–94.CrossRef
17.
go back to reference Imbeni V, Kruzic JJ, Marshall GW, Marshall SJ, Ritchie RO. The dentin-enamel junction and the fracture of human teeth. Nat Mater. 2005;4(3):229–32.CrossRef Imbeni V, Kruzic JJ, Marshall GW, Marshall SJ, Ritchie RO. The dentin-enamel junction and the fracture of human teeth. Nat Mater. 2005;4(3):229–32.CrossRef
18.
go back to reference Dusevich V, Xu C, Wang Y, Walker MP, Gorski JP. Identification of a protein-containing enamel matrix layer which bridges with the dentine-enamel junction of adult human teeth. Arch Oral Biol. 2012;57(12):1585–94.CrossRef Dusevich V, Xu C, Wang Y, Walker MP, Gorski JP. Identification of a protein-containing enamel matrix layer which bridges with the dentine-enamel junction of adult human teeth. Arch Oral Biol. 2012;57(12):1585–94.CrossRef
19.
go back to reference al-Nawas B, Grotz KA, Rose E, Duschner H, Kann P, Wagner W. Using ultrasound transmission velocity to analyse the mechanical properties of teeth after in vitro, in situ, and in vivo irradiation. Clin Oral Investig. 2000;4(3):168–72.CrossRef al-Nawas B, Grotz KA, Rose E, Duschner H, Kann P, Wagner W. Using ultrasound transmission velocity to analyse the mechanical properties of teeth after in vitro, in situ, and in vivo irradiation. Clin Oral Investig. 2000;4(3):168–72.CrossRef
20.
go back to reference Gellrich NC, Schramm A, Bockmann R, Kugler J. Follow-up in patients with oral cancer. J Oral Maxillofac Surg. 2002;60(4):380–6.CrossRef Gellrich NC, Schramm A, Bockmann R, Kugler J. Follow-up in patients with oral cancer. J Oral Maxillofac Surg. 2002;60(4):380–6.CrossRef
21.
go back to reference Giannini M, Soares CJ, de Carvalho RM. Ultimate tensile strength of tooth structures. Dent Mater. 2004;20(4):322–9.CrossRef Giannini M, Soares CJ, de Carvalho RM. Ultimate tensile strength of tooth structures. Dent Mater. 2004;20(4):322–9.CrossRef
22.
go back to reference Cole T, Silver AH. Production of hydrogen atoms in teeth by x-irradiation. Nature. 1963;200:700–1.CrossRef Cole T, Silver AH. Production of hydrogen atoms in teeth by x-irradiation. Nature. 1963;200:700–1.CrossRef
23.
go back to reference Knychalska-Karwan Z, Pawlicki R, Karwan T. Structural and microanalytical changes in dentition after radiotherapy applied in cases of tumour in the oral cavity region. Folia Histochem Cytobiol. 1988;26(1):25–32.PubMed Knychalska-Karwan Z, Pawlicki R, Karwan T. Structural and microanalytical changes in dentition after radiotherapy applied in cases of tumour in the oral cavity region. Folia Histochem Cytobiol. 1988;26(1):25–32.PubMed
24.
go back to reference Chun K, Choi H, Lee J. Comparison of mechanical property and role between enamel and dentin in the human teeth. J Dent Biomech. 2014;5:1758736014520809.PubMedPubMedCentral Chun K, Choi H, Lee J. Comparison of mechanical property and role between enamel and dentin in the human teeth. J Dent Biomech. 2014;5:1758736014520809.PubMedPubMedCentral
25.
go back to reference Soares CJ, Castro CG, Neiva NA, Soares PV, Santos-Filho PC, Naves LZ, Pereira PN. Effect of gamma irradiation on ultimate tensile strength of enamel and dentin. J Dent Res. 2010;89(2):159–64.CrossRef Soares CJ, Castro CG, Neiva NA, Soares PV, Santos-Filho PC, Naves LZ, Pereira PN. Effect of gamma irradiation on ultimate tensile strength of enamel and dentin. J Dent Res. 2010;89(2):159–64.CrossRef
26.
go back to reference Reed R, Xu C, Liu Y, Gorski JP, Wang Y, Walker MP. Radiotherapy effect on nano-mechanical properties and chemical composition of enamel and dentine. Arch Oral Biol. 2015;60(5):690–7.CrossRef Reed R, Xu C, Liu Y, Gorski JP, Wang Y, Walker MP. Radiotherapy effect on nano-mechanical properties and chemical composition of enamel and dentine. Arch Oral Biol. 2015;60(5):690–7.CrossRef
27.
go back to reference Franzel W, Gerlach R. The irradiation action on human dental tissue by x-rays and electrons—a nanoindenter study. Z Med Phys. 2009;19(1):5–10.CrossRef Franzel W, Gerlach R. The irradiation action on human dental tissue by x-rays and electrons—a nanoindenter study. Z Med Phys. 2009;19(1):5–10.CrossRef
28.
go back to reference McGuire JD, Gorski JP, Dusevich V, Wang Y, Walker MP. Type IV collagen is a novel DEJ biomarker that is reduced by radiotherapy. J Dent Res. 2014;93(10):1028–34.CrossRef McGuire JD, Gorski JP, Dusevich V, Wang Y, Walker MP. Type IV collagen is a novel DEJ biomarker that is reduced by radiotherapy. J Dent Res. 2014;93(10):1028–34.CrossRef
29.
go back to reference Pioch T, Golfels D, Staehle HJ. An experimental study of the stability of irradiated teeth in the region of the dentinoenamel junction. Endod Dent Traumatol. 1992;8(6):241–4.CrossRef Pioch T, Golfels D, Staehle HJ. An experimental study of the stability of irradiated teeth in the region of the dentinoenamel junction. Endod Dent Traumatol. 1992;8(6):241–4.CrossRef
30.
go back to reference Zhang X, Li YJ, Wang SL, Xie JY. Effect of irradiation on tooth hard tissue and its resistance to acid. Zhonghua Kou Qiang Yi Xue Za Zhi. 2004;39(6):463–6 (in Chinese).PubMed Zhang X, Li YJ, Wang SL, Xie JY. Effect of irradiation on tooth hard tissue and its resistance to acid. Zhonghua Kou Qiang Yi Xue Za Zhi. 2004;39(6):463–6 (in Chinese).PubMed
31.
go back to reference Verrone JR, Alves Fde A, Prado JD, Boccaletti KW, Sereno MP, Silva ML, Jaguar GC. Impact of intraoral stent on the side effects of radiotherapy for oral cancer. Head Neck. 2013;35(7):E213–7.CrossRef Verrone JR, Alves Fde A, Prado JD, Boccaletti KW, Sereno MP, Silva ML, Jaguar GC. Impact of intraoral stent on the side effects of radiotherapy for oral cancer. Head Neck. 2013;35(7):E213–7.CrossRef
32.
go back to reference Duarte VM, Liu YF, Rafizadeh S, Tajima T, Nabili V, Wang MB. Comparison of dental health of patients with head and neck cancer receiving IMRT vs conventional radiation. Otolaryngol Head Neck Surg. 2014;150(1):81–6.CrossRef Duarte VM, Liu YF, Rafizadeh S, Tajima T, Nabili V, Wang MB. Comparison of dental health of patients with head and neck cancer receiving IMRT vs conventional radiation. Otolaryngol Head Neck Surg. 2014;150(1):81–6.CrossRef
33.
go back to reference Abdalla R, Niazy MA, Jamil WE, Hazzaa HA, Elbatouti AA. The role of fluoride and chlorhexidine in preserving hardness and mineralization of enamel and cementum after gamma irradiation. Radiat Environ Biophys. 2017;56(2):187–92.CrossRef Abdalla R, Niazy MA, Jamil WE, Hazzaa HA, Elbatouti AA. The role of fluoride and chlorhexidine in preserving hardness and mineralization of enamel and cementum after gamma irradiation. Radiat Environ Biophys. 2017;56(2):187–92.CrossRef
34.
go back to reference Buglione M, Cavagnini R, Di Rosario F, Maddalo M, Vassalli L, Grisanti S, Salgarello S, Orlandi E, Bossi P, Majorana A, Gastaldi G, Berruti A, Trippa F, Nicolai P, Barasch A, Russi EG, Raber-Durlacher J, Murphy B, Magrini SM. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: dental pathologies and osteoradionecrosis (part 1) literature review and consensus statement. Crit Rev Oncol Hematol. 2016;97:131–42.CrossRef Buglione M, Cavagnini R, Di Rosario F, Maddalo M, Vassalli L, Grisanti S, Salgarello S, Orlandi E, Bossi P, Majorana A, Gastaldi G, Berruti A, Trippa F, Nicolai P, Barasch A, Russi EG, Raber-Durlacher J, Murphy B, Magrini SM. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: dental pathologies and osteoradionecrosis (part 1) literature review and consensus statement. Crit Rev Oncol Hematol. 2016;97:131–42.CrossRef
Metadata
Title
Direct radiation-induced effects on dental hard tissue
Authors
Hui Lu
Qi Zhao
Jiang Guo
Binghui Zeng
Xinlin Yu
Dongsheng Yu
Wei Zhao
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-019-1208-1

Other articles of this Issue 1/2019

Radiation Oncology 1/2019 Go to the issue