Cellular death but not genetic damage in oral mucosa cells after exposure to digital lateral radiography

Is micronucleus assay a suitable method for biomonitoring children exposed to X-ray? A systematic review with meta-analysis

PURPOSE

The aim of this study was to evaluate if the micronucleus test using oral epithelial cells is a suitable biomarker for biomonitoring children exposed to X-ray.

MATERIAL AND METHODS

A search was performed through the electronic databases PubMed/Medline, Scopus, and Web of Science, all studies published up to February 2022 that examined the relationship between exposure of children to radiographic examinations and micronucleus.

RESULTS

A total of 17 full-text manuscripts were screened for eligibility. Only two studies found a difference in micronucleus labeling. On the other hand, all studies showed that X-ray was able to induce cellular death in oral mucosa cells. Following the parameters of the Effective Practices in Public Health Project (EPHPP), five manuscripts reached moderate and strong scores, and four studies were categorized as weak at final rating. In the meta-analysis, statistically significant difference was detected in micronucleated cells in children before and after radiographic examinations (SMD = 0.96, 95% CI, 0.07-1.84, p = .04), with τ2=1.09; χ2=53.37, and p < .001.

CONCLUSION

Radiographic examinations in children can cause genotoxic and cytotoxic damage in the oral epithelium with a large effect size.

Cytotoxicity, genotoxicity, and immunohistochemical expression of p53 in the oral mucosal epithelium of adults following cone-beam computed tomography

This study sought to assess the cytotoxicity, genotoxicity, and immunohistochemical (IHC) expression of p53 in the oral mucosal epithelium of adults following cone-beam computed tomography (CBCT). This before-and-after observational study evaluated 30 patients (15 males and 15 females); mean age 35 years, who required CBCT. Exfoliating epithelial cells of the buccal mucosa were collected with a cotton swab immediately before and 10 days after CBCT. Following Papanicolaou staining, genotoxicity was evaluated by the micronucleus assay. The frequencies of pyknosis, karyorrhexis, karyolysis, budding and binucleation as cytotoxicity factors were also recorded. Expression of p53 was evaluated by IHC staining. Data were analyzed by paired samples t-test. Micronucleated cells, pyknosis, karyorrhexis, karyolysis, budding, cytotoxicity, and expression of p53 increased significantly after CBCT. CBCT exerts genotoxic and cytotoxic effects and leads to overexpression of p53 protein in the oral buccal mucosal cells.

Cytogenetic analysis (buccal micronucleus cytome assay) of radioactive waste management workers

The Russian Federation is implementing a program for dismantling nuclear-powered submarines and nuclear service vessels decommissioned from the Navy. Program personnel may be exposed to mutagenic and carcinogenic factors, including ionizing radiation. Improved preclinical health diagnostics are desirable, for timely identification of health effects, optimization of preventive measures, and medical interventions. We used an improved version of the buccal micronucleus cytome assay (BMCyt) to conduct cytogenetic status assessment of 59 employees of the Far Eastern Center for Radioactive Waste Management (DalRAO). We observed a statistically significant increase in the frequency of buccal epithelial cells with cytogenetic abnormalities (2.31‰ versus 1.15‰) and a small decrease in the apoptotic index (42 % versus 44 %) in the exposure group vs. controls. An accumulation index of cytogenetic disorders (the ratio of cells with nuclear abnormalities to cells in apoptosis) was determined and significant differences were found between the exposure and control groups. The proposed approach is simple, non-invasive, and highly informative for monitoring the health status of personnel exposed to complex factors in the working environment.

Radiobiological risks following dentomaxillofacial imaging: should we be concerned?

OBJECTIVES

This review aimed to present studies that prospectively investigated biological effects in patients following diagnostic dentomaxillofacial radiology (DMFR).

METHODS

Literature was systematically searched to retrieve all studies assessing radiobiological effects of using X-ray imaging in the dentomaxillofacial area, with reference to radiobiological outcomes for other imaging modalities and fields.

RESULTS

There is a lot of variability in the reported radiobiological assessment methods and radiation dose measures, making comparisons of radiobiological studies challenging. Most radiological DMFR studies are focusing on genotoxicity and cytotoxicity, data for 2D dentomaxillofacial radiographs, albeit with some methodological weakness biasing the results. For CBCT, available evidence is limited and few studies include comparative data on both adults and children.

CONCLUSIONS

In the future, one will have to strive towards patient-specific measures by considering age, gender and other individual radiation sensitivity-related factors. Ultimately, future radioprotection strategies should build further on the concept of personalized medicine, with patient-specific optimization of the imaging protocol, based on radiobiological variables.

A comprehensive review of the literature on the biological effects from dental X-ray exposures

PURPOSE

Routine dental X-rays are among the most common sources of ionizing radiation exposure for healthy individuals globally, with 300 examinations/1000 individuals/year as documented by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) global survey of medical radiation usage and exposure. Furthermore, in the United States of America, an increased use of dental radiography is evident. However, with the shift from using film to digital image receptors, the dose of radiation per routine examination has decreased. Despite this, there remains public concern of dental X-rays. This continuing concern highlights the need to review the literature on biological and health effects related to exposure, from dental X-rays.

MATERIAL AND METHODS

This report presents studies investigating biological and health effects related to exposures using dental X-rays in patients and provides a critical evaluation. Relevant studies specific to dental X-rays are reviewed from 1970 and onward with the bulk data in this field resulting from epidemiological and biomonitoring studies.

RESULTS

While, most epidemiological studies suggest a possible correlation between head/neck related tumors and exposure to dental X-rays, evidence for causation is lacking. Biomonitoring studies suggest that exposure to low-level radiation such as that of dental radiography may not be a factor in inducing long-term chromosomal damage, but may result in localized cytotoxicity in the irradiated region of the mouth, with no long-term harm.

CONCLUSIONS

In general, the total number of studies is low and the majority of the data has been generated from poorly designed experiments. This review will highlight shortcomings that could influence outcomes and provide a more balanced interpretation that could impact the public perception and the level of public concern on the health effects resulting from dental X-rays.

Buccal mucosa cell damage in individuals following dental X-ray examinations

The aim of the present study was to monitor genotoxic and cytotoxic effect of X-ray on exfoliated buccal mucosa cells and investigate the association between the effects and the accumulated absorbed doses of oral mucosa. 98 participants’ buccal mucosa cells were collected before and 10 days after different series of dental radiographs performed. Cytological preparations were successively dyed with the methods of Feulgen and fast-green, and analyzed under a light microscope. Micronuclei (MN)and other cells were scored. Accumulated absorbed dose of buccal mucosa was estimated with the method of anthropomorphic phantom and dosimeter chips. The dose rang was 0.18–3.54 mGy. A significant difference in the rate of MN cell was found before and after X-ray examinations (P = 0.008) as well as in the rates of Pyknotic (p < 0.001) and Karyolytic cell (p = 0.0021). When only the patients whose mucosa absorbed dose is lower than 1 mGy was analyzed, significant differences were not found except for Karyolytic cells (p = 0.0313). There was a correlation between the accumulated does and the change rate (ρ = 0.25, p = 0.0118). The frequency of micronuclei cells in buccal mucosa may be increased when a series of dental radiographs including a CBCT examination was performed.

Evidence of genotoxicity and cytotoxicity of X-rays in the oral mucosa epithelium of adults subjected to cone beam CT

OBJECTIVES

To assess cytological evidence of genotoxicity and cytotoxicity of X-rays in oral exfoliated cells of adults subjected to partial and total cone beam CT (CBCT) (stitching module) by means of micronuclei frequency, associated with counting of degenerative nuclear alterations (pyknosis, karyolysis, karyorrhexis, buds and broken eggs), besides comparing the partial and total CBCT (stitching module) in search of possible differences in the nature and/or intensity of the effects.

METHODS

29 adults who were referred to total or partial CBCT were selected. All CBCT were performed with a Carestream CS 9000 3D scanner (Carestream Health Inc., Rochester, NY). Material collection was done immediately before CBCT and 10 days later, by scraping the left and right cheek mucosa with a plastic spatula. Statistical analysis was performed using the Wilcoxon test (paired data), at a significance level of 5%.

RESULTS

The statistically significant difference was noted in the frequency of micronucleated cells for both partial and total acquisition (p = 0.008 and p < 0.001, respectively). Regarding to cytotoxicity, there was a statistically significant difference for both partial and total acquisition (p < 0.001 and p < 0.001, respectively).

CONCLUSIONS

The partial and total CBCT seems to offer risks of inducing genetic damage. In addition both forms of CBCT acquisition have promoted the induction of cytotoxic nuclear alterations.

GENOTOXICIDADE E CITOTOXICIDADE DOS RAIOS X EM CRIANÇAS SUBMETIDAS À RADIOGRAFIA PANORÂMICA

RESUMO Objetivo: Analisar a genotoxicidade e a citotoxicidade produzidas por raios X no epitélio da mucosa oral de crianças durante a obtenção da radiografia panorâmica. Métodos: A amostra foi constituída por 30 crianças saudáveis, sendo 19 do sexo feminino e 11 do masculino, com faixa etária de 4 a 10 anos (média de 7 anos de idade). As células epiteliais da mucosa oral foram coletadas por meio de citologia esfoliativa em base líquida imediatamente antes e após sete dias da obtenção da radiografia panorâmica. Os esfregaços foram processados e corados utilizando a técnica de Feulgen Rossenbeck modificada. Foram analisadas e quantificadas projeções nucleares dos tipos bud e broken egg, alterações genotóxicas na forma de micronúcleo e alterações citotóxicas dos tipos picnose, cariólise e cariorrexe. Resultados: A frequência de picnose, bud e broken egg foi significativamente maior após a exposição aos raios X (p<0,05), porém não houve diferença estatisticamente significante em relação ao sexo, bem como nas demais alterações estudadas. Conclusões: A exposição aos raios X emitidos durante a obtenção da radiografia panorâmica pode induzir à morte celular no epitélio da mucosa oral de crianças. Não foi encontrado indício significativo de efeito genotóxico.

Buccal mucosa micronuclei counts in relation to exposure to low dose-rate radiation from the Chornobyl nuclear accident and other medical and occupational radiation exposures

BACKGROUND

Ionizing radiation is a well-known carcinogen. Chromosome aberrations, and in particular micronuclei represent an early biological predictor of cancer risk. There are well-documented associations of micronuclei with ionizing radiation dose in some radiation-exposed groups, although not all. That associations are not seen in all radiation-exposed groups may be because cells with micronuclei will not generally pass through mitosis, so that radiation-induced micronuclei decay, generally within a few years after exposure.

METHODS

Buccal samples from a group of 111 male workers in Ukraine exposed to ionizing radiation during the cleanup activities at the Chornobyl nuclear power plant were studied. Samples were taken between 12 and 18 years after their last radiation exposure from the Chornobyl cleanup. The frequency of binucleated micronuclei was analyzed in relation to estimated bone marrow dose from the cleanup activities along with a number of environmental/occupational risk factors using Poisson regression adjusted for overdispersion.

RESULTS

Among the 105 persons without a previous cancer diagnosis, the mean Chornobyl-related dose was 59.5 mSv (range 0-748.4 mSv). There was a borderline significant increase in micronuclei frequency among those reporting work as an industrial radiographer compared with all others, with a relative risk of 6.19 (95% CI 0.90, 31.08, 2-sided p = 0.0729), although this was based on a single person. There was a borderline significant positive radiation dose response for micronuclei frequency with increase in micronuclei per 1000 scored cells per Gy of 3.03 (95% CI -0.78, 7.65, 2-sided p = 0.1170), and a borderline significant reduction of excess relative MN prevalence with increasing time since last exposure (p = 0.0949). There was a significant (p = 0.0388) reduction in MN prevalence associated with bone X-ray exposure, but no significant trend (p = 0.3845) of MN prevalence with numbers of bone X-ray procedures.

CONCLUSIONS

There are indications of increasing trends of micronuclei prevalence with Chornobyl-cleanup-associated dose, and indications of reduction in radiation-associated excess prevalence of micronuclei with time after exposure. There are also indications of substantially increased micronuclei associated with work as an industrial radiographer. This analysis adds to the understanding of the long-term effects of low-dose radiation exposures on relevant cellular structures and methods appropriate for long-term radiation biodosimetry.

Cytogenetic Biomonitoring in Buccal Mucosa Cells from Young Smokers

OBJECTIVE

Nowadays, much attention has been focused on the search for new non-invasive methodologies able to predict malignant transformation of oral mucosa cells. The aim of the present study was to comparatively evaluate DNA damage (micronucleus) and cellular death (pyknosis, karyolysis and karyorrhexis) in exfoliated oral mucosa cells from smokers and non-smokers in buccal mucosa cells.

STUDY DESIGN

A total of 24 young, healthy smokers and 14 non-smokers were included in this setting. Individuals had epithelial cells from the cheek mechanically exfoliated, placed in fixative and dropped in clean slides which were checked for the above nuclear phenotypes.

RESULTS

Smokers presented more (p < 0.05) micronucleated oral mucosa cells than non-smokers. Tobacco smoke was not able to increase other nuclear alterations closely related to cytotoxicity such as karyorrhexis, pyknosis and karyolysis.

CONCLUSION

In summary, these data indicate that the cigarette is able to induce micronuclei in oral mucosa cells, so the micronucleus test is a suitable method for predicting oral cancer risk.

Mutagenicity and cytotoxicity in patients submitted to ionizing radiation

OBJECTIVES

To evaluate and compare mutagenicity (micronucleus) and cytotoxicity (karyorrhexis, pyknosis, and karyolysis) in exfoliated buccal mucosa cells of children following cone beam computed tomography (CBCT) or conventional radiograph exposure necessary for orthodontic planning.

MATERIALS AND METHODS

A total of 49 healthy children were submitted to CBCT or a conventional orthodontic radiographic protocol; they were divided into two groups based on exam: CBCT (n  =  24) and Radiographic Set (n  =  25) groups. The micronucleus test in the exfoliated buccal mucosa cells was applied.

RESULTS

There was not a statistically significant difference (P > .05) found between the number of micronucleated buccal mucosa cells (MNC) before and after exposure to radiation in either group, showing that neither group experienced a mutagenic effect. However, radiation did cause other nuclear alterations closely related to cytotoxicity, including karyorrhexis, pyknosis, and karyolysis, in both groups (P < .05). The CBCT group presented a greater increase in cell death than was noted in the Radiographic Set group (P < .044).

CONCLUSION

According to the micronucleus test, mutagenicity was not induced by the CBCT or the conventional radiographs, but cytotoxicity was verified after these exams, especially after CBCT. That might have happened once the CBCT group received a greater radiation dose than the Radiographic Set group as a result of the protocols used in orthodontic planning for this study.

Cytogenetic biomonitoring in oral mucosa cells following dental X-ray

OBJECTIVES

In the past decades, X-rays have been used widely for diagnosis in dentistry. However, it is well known that ionizing radiation causes damage (including single- and double-strand breaks) to deoxyribonucleic acid (DNA) and DNA-protein crosslinks, and induces cellular death. Therefore, outlining the cytogenetic effects induced by X-ray is necessary to identify the degree of cancer risk and minimize potential risks to patients and clinicians. To date, a variety of assays have been proposed in cytogenetic biomonitoring studies, including those that assess metaphase chromosomal aberrations and sister chromatid exchanges, and micronucleus and single-cell gel (comet) assay.

METHODS

Cytogenetic biomonitoring studies focusing on oral mucosa cells in individuals exposed to dental X-ray were reviewed.

RESULTS

Dental X-ray can induce DNA damage and cytotoxicity in oral mucosa cells.

CONCLUSION

These results will contribute to a better understanding of X-ray-induced effects upon the cellular system in individuals continually exposed to known genotoxic/cytotoxic agents.

Cytogenetic biomonitoring in children submitting to a complete set of radiographs for orthodontic planning

OBJECTIVES

To evaluate the DNA damage (micronucleus) and cellular death (pyknosis, karyolysis, and karyorrhexis) in exfoliated buccal mucosa cells from children undergoing orthodontic radiographs.

MATERIALS AND METHODS

A total of 25 healthy children undergoing orthodontic therapy partook in a complete set of orthodontic radiographs (lateral cephalographic, posteroanterior cephalographic, panoramic, full periapical exam, and bitewing). The micronucleus test in the buccal exfoliated cells was applied. The paired-samples t-test and the Wilcoxon test were used to compare the frequencies of alterations before and after X-ray exposure.

RESULTS

We found no statistically significant differences (P > .05) between micronucleated buccal mucosa cells before and after exposure to radiation. However, radiation did cause other nuclear alterations closely related to cytotoxicity (P  =  .007).

CONCLUSION

According to the micronucleus test, the complete set of radiographs requested in the orthodontic planning may not be a factor that induces chromosomal damage, but it is able to promote cytotoxicity.