Impact of hypo-salivation on severe tooth wear: A ten-year cohort of patients received radiotherapy for nasopharyngeal carcinoma

Abrasive challenge effects on enamel and dentin from irradiated human teeth: an in vitro study

This study aimed to evaluate the effects of radiotherapy (RT) and chemoradiotherapy (CRT) on the wear and surface roughness of in vitro irradiated human enamel and dentin subjected to abrasive challenge. Enamel and dentin specimens (n = 42) were prepared from teeth donated by healthy patients and those with head and neck cancer who had received radiotherapy (RT) or chemoradiotherapy (CRT). The specimens were categorized into three groups: control, RT, and CRT (n = 14 per group for both enamel and dentin). These samples were subjected to an in vitro abrasive experiment using a brushing machine, followed by wear and surface roughness assessments with a confocal laser scanning microscope conducted before and after the abrasive challenge, considering both exposed and non-exposed areas. Statistical analysis used Shapiro-Wilk tests for normality, Wilcoxon tests for comparing two means, and Kruskal-Wallis tests. A significance level of 5% was adopted. In enamel specimens, wear profile values ​​of CRT and RT groups were not different from the control (p > 0.05). The RT group presents lower step values than the CRT and control groups (p < 0.001). No significant difference in final surface roughness was observed in all groups (p > 0.05). In dentin specimens, no significant difference in wear profile and step was observed in all groups (p > 0.05). However, CRT and RT groups present higher values in final surface roughness (p < 0.001). The exposure to ionizing radiation (associated or not to chemotherapy) influenced the surface roughness of dentin and the wear (step) of enamel after the in vitro abrasive challenge.Trial registration: Ethical procedures were approved by the FORP/USP Research Ethics Committee (CAAE: 61308416.4.0000.5419), and Hospital do Câncer de Barretos/Fundação Pio XII (CAAE: 61308416.4.3001.5437).

From medical strategy to foodborne prophylactic strategy: Stabilizing dental collagen with aloin

Infectious oral diseases are longstanding global public health concerns. However, traditional medical approaches to address these diseases are costly, traumatic, and prone to relapse. Here, we propose a foodborne prophylactic strategy using aloin to safeguard dental collagen. The effect of aloin on the stability of dental collagen was evaluated by treating dentin with a solution containing aloin (0.1 mg/mL) for 2 min. This concentration is comparable to the natural aloin content of edible aloe. Furthermore, we investigated the mechanisms underlying the interactions between aloin and dentin collagen. Our findings, obtained through fluorescence spectroscopy, attenuated total reflection Fourier transform infrared spectroscopy, Gaussian peak fitting, circular dichroism spectroscopy, and X-ray diffraction, revealed that aloin interacts with dental collagen through noncovalent bonding, specifically hydrogen bonding in situ. This interaction leads to a reduction in the distance between molecules and an increase in the proportion of stable α-helical chains in the dental collagen. The ultimate tensile strength and thermogravimetric analysis demonstrated that dental collagen treated with aloin exhibited improved mechanical strength and thermostability. Additionally, the release of hydroxyproline, cross-linked carboxy-terminal telopeptide of type I collagen, and C-terminal cross-linked telopeptide of type I collagen, along with weight loss, indicated an enhancement in the enzymatic stability of dental collagen. These findings suggest that aloin administration could be a daily, nondestructive, and cost-effective strategy for managing infectious oral diseases.

A qualitative analysis of patient's lived experience on their treatment journey with nasopharyngeal carcinoma

OBJECTIVE

To explore and analyse the perspective of patients undergoing and recovering from nasopharyngeal carcinoma (NPC) therapy.

METHODS

Thirty-three NPC patients at different stages of treatment were enrolled. Seven were actively undergoing treatment, 13 were immediately post-treatment, and 13 were long-term. Patients were interviewed using a structured questionnaire based on a review of the literature that covered different phases of their treatment journey. The interview was recorded and transcribed for qualitative data analysis using a thematic inductive-deductive approach.

RESULTS

Three main domains embracing aspects of NPC patients' experiences were identified; side effects, psychosocial well-being, and the role and support of healthcare workers. Side effects were experienced orally, locally, and systemically. Oral side effects (oral mucositis, xerostomia, altered taste, dysphagia) were the most significant challenge experienced by NPC patients. Locally, skin injury (desquamation, fibrosis, darkening of the skin, erythema, pruritus, and swelling around the neck region) and hair loss, resolved after cessation of therapy. Systemic side effects from the treatment were related to general weakness, weight loss and nausea. The psychosocial well-being of NPC patients was influenced by a range of issues including support (healthcare workers and family), pain management, functional limitations, nutritional needs, perceived level of information, emotion, and finances.

CONCLUSION

NPC patients were significantly impacted based on the diagnosis, treatment and recovery phase affecting them locally, systemically, and psychologically. The role of family and healthcare staff was also influential in the overall treatment experience, and they have key roles to play in facilitating patients along their treatment journey.

CLINICAL SIGNIFICANCE

Oral and general side effects from NPC treatment have significant impact on patients physical and emotional well-being. It is important for healthcare providers to have insights of these so as to understand and support patients during their treatment journey and recovery and be able to empathetically facilitate their clinical management.

The interrelationship between xerogenic medication use, subjective oral dryness and tooth wear

OBJECTIVE

To investigate the association between xerogenic medication use and tooth wear among American adults and whether this association can be explained by subjective oral dryness.

METHODS

We used data from 3578 adults who participated in the National Health and Nutritional Examination Survey (NHANES). Tooth wear was clinically determined using the modified Tooth Wear Index. Information on xerogenic medication use, subjective oral dryness (amount of saliva in mouth and feeling the mouth dry when eating) and potential confounders (sociodemographic factors, dental insurance coverage, gastroesophageal reflux disease medication use and soft drinks intake) were self-reported. The associations among xerogenic medication use, subjective oral dryness and tooth wear were assessed in regression models adjusting for confounders.

RESULTS

Adults taking xerogenic medication had greater odds of reporting too little amount of saliva and feeling the mouth dry when eating. In addition, participants taking one and multiple (two or more) xerogenic medications had, respectively, 1.53 (95 % CI: 1.01-2.32) and 1.44 (95 % CI: 0.62-3.33) greater odds of having tooth wear than those taking no xerogenic medications. In a regression model including all explanatory variables, the association of xerogenic medication use with tooth wear was fully attenuated whereas subjective oral dryness (amount of saliva in mouth but not feeling the mouth dry when eating) remained positively associated with prevalence of tooth wear. Similar findings were obtained with long-term use of xerogenic medication (in the past month and for three or more years).

CONCLUSION

Current (last month) use of xerogenic medication was associated with the presence of tooth wear. This association was accounted for by subjective indicators of oral dryness.

CLINICAL SIGNIFICANCE

Dentists should be familiar with the possible connection between patient's medical prescription and tooth wear. Changing prescriptions to non-xerogenic alternatives, whenever possible, could improve patients' oral condition. The findings also suggest that patients may recognise, through the perception of dry mouth, when medication is placing them at risk.