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Luka B, Fiedler A, Ganss C, Soetedjo V, Vach K, Schlueter N. PREVENTING CARIES AFTER RADIOTHERAPY TO THE HEAD AND NECK REGION - A SYSTEMATIC REVIEW. J Evid Based Dent Pract 2024; 24:101989. [PMID: 39174170 DOI: 10.1016/j.jebdp.2024.101989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES Radiotherapy to the head and neck region (HN) bears the risk of a rampant development of caries, making intensified prevention necessary. Aim of this systematic review was to summarize the evidence on the efficacy of caries preventive measures in these patients. METHODS Clinical studies investigating caries in patients with radiotherapy in the HN with at least 1 caries preventive intervention compared to any control were included. Reports in languages other than English or German were excluded. Records were identified on PubMed, Web of Science, Google Scholar, and Cochrane Library mid-January 2024. Risk of bias was assessed with RoB2. Results were summarized. Planned meta-analyses could not be performed, because of heterogenous data. RESULTS Five studies were included, with a total of 355 participants. They were irradiated with up to 70 Gy and received different caries preventive interventions, including sodium fluoride or stannous fluoride gels, remineralizing solutions, an "Intraoral Fluoride Release System" and sucrose restricted diet. Caries score increased between 0.48 DMF-S and 9.2 DF-S per year. Largest differences in caries increments were measured between groups with insufficient and with rigorous fluoride application. CONCLUSIONS The main limitations were compromised randomization, heterogeneity of patients and small sample sizes. Clinical studies on caries prevention after radiotherapy to the HN are lacking and the existing ones bear extensive limitations. However, the large effect size and broad consensus suggest the use of fluoride to be indispensable in preventing caries in these patients. The study was funded by the Medical Center - University of Freiburg and was not registered.
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Affiliation(s)
- Benedikt Luka
- Hannover Medical School, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - Annelie Fiedler
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Carolina Ganss
- Department for Operative Dentistry, Endodontics, and Pediatric Dentistry, Section Cariology of Ageing, Philipps-University Marburg, Georg-Voigt-Str. 3, 35039 Marburg, Germany
| | - Veronika Soetedjo
- Institute of Medical Biometry and Statistics, Medical Center, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany
| | - Kirstin Vach
- Hannover Medical School, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; Institute of Medical Biometry and Statistics, Medical Center, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany
| | - Nadine Schlueter
- Hannover Medical School, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Monteiro RV, Lins RBE, Lima RBW, Fischer K, De Souza GM. Preventive and restorative alternatives to caries by irradiation: a scoping review. Support Care Cancer 2024; 32:327. [PMID: 38702458 DOI: 10.1007/s00520-024-08522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE This study is to conduct a comprehensive scoping review to map scientific evidence and clarify concepts regarding the commonly recommended preventive and restorative dental treatments for patients diagnosed with head and neck cancer (HNC) and subjected to radiotherapy. MATERIAL AND METHODS This systematic scoping review was performed under the PRISMA-ScR guidelines. The study's experimental design was registered in the Open Science Framework. In vitro studies that evaluated preventive and restorative dental treatment over 50 Gy radiation doses were included. The search was conducted in November 2023 in five electronic databases (PubMed, Scopus, Web of Science, Cochrane Library, and Embase) without language or date restriction. A search strategy was applied based on keywords, MeSh terms, or synonyms. A descriptive analysis was conducted. RESULTS A total of 49 studies, out of 3679 original articles identified, were included and reviewed. Of the included studies, three evaluated saliva stimulants and 35 evaluated fluoride-based preventive materials: gel (n = 18) toothpaste (n = 11) mouth rinse (n = 8) and varnish (n = 5) while 14 evaluated restorative materials: resin composite (n = 12) glass ionomer cement (n = 6) and amalgam (n = 1) Of those studies, 36 were clinical trials and 13 were in vitro studies. CONCLUSION Fluoride gel was the most frequently recommended preventive material for preventing radiation caries with supportive clinical evidence. Resin composite and glass ionomer were the most frequently used restorative materials, respectively. However, there is not yet clinical evidence to support the use of resin composite in irradiated teeth.
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Affiliation(s)
- Renata V Monteiro
- Department of Comprehensive Dentistry, School of Dentistry, University of Louisville, 501 S Preston St, Louisville, KY, 40202, USA.
| | - Rodrigo B E Lins
- Department of Restorative Dentistry, School of Dentistry, Federal University of Alagoas, Lourival Melo Mota Ave, Maceió, Alagoas, 57072-900, Brazil
| | - Renally B W Lima
- Department of Restorative Dentistry, School of Dentistry, Federal University of Paraíba, I Lot. Cidade Universitária, João Pessoa, Paraíba, 58051-900, Brazil
| | - Kathleen Fischer
- Department of Comprehensive Dentistry, School of Dentistry, University of Louisville, 501 S Preston St, Louisville, KY, 40202, USA
| | - Grace M De Souza
- Department of Comprehensive Dentistry, School of Dentistry, University of Louisville, 501 S Preston St, Louisville, KY, 40202, USA
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Nath J, Singh PK, Sarma G. Dental Care in Head and Neck Cancer Patients Undergoing Radiotherapy. Indian J Otolaryngol Head Neck Surg 2022; 74:6219-6224. [PMID: 36742621 PMCID: PMC9895163 DOI: 10.1007/s12070-021-02941-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
External beam radiotherapy is an integral part of the management of head and neck cancer. Radiotherapy for head and neck cancer lead to many treatment-related toxicities, including a wide range of dental morbidities. These complications depend on the various patient and treatment-related factors. Patients with poor oral hygiene, pre-existing periodontal disease, and the conventional mode of radiotherapy delivery are major factors leading to acute and severe late dental problems. Most of the complications are preventable with proper oral and dental care before, during and after radiotherapy. Pre radiotherapy dental evaluation to diagnose patients with potential risk and timely intervention can reduce long-term morbidities like carries, osteoradionecrosis, etc., thereby improving patients' quality of life. This article highlights the various aspects of dental care and management in head neck cancer patients before, during and after radiation therapy.
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Affiliation(s)
- Jyotiman Nath
- Department of Radiation Oncology, Dr B Boorach Cancer Institute, Guwahati, Assam 781016 India
| | | | - Gautam Sarma
- Department of Radiation Oncology, Dr B Boorach Cancer Institute, Guwahati, Assam 781016 India
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Fernando JR, Walker GD, Park TKS, Shen P, Yuan Y, Reynolds C, Reynolds EC. Comparison of calcium-based technologies to remineralise enamel subsurface lesions using microradiography and microhardness. Sci Rep 2022; 12:9888. [PMID: 35701508 PMCID: PMC9197824 DOI: 10.1038/s41598-022-13905-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Assessment of enamel subsurface lesion remineralisation is essential for the evaluation of novel remineralisation technologies. The gold standard to assess subsurface mineral gain of enamel lesions is transverse microradiography (TMR). However, some studies have utilised surface microhardness (SMH) to evaluate efficacy of remineralisation agents. The aim of this study was to assess remineralisation of enamel subsurface lesions using TMR and SMH after in vitro treatment with calcium-containing technologies, and to test correlation between the TMR and SMH measurements. The parameters obtained from the TMR and SMH analyses of enamel subsurface remineralisation were not significantly correlated. Furthermore, the enamel subsurface remineralisation as measured by TMR was significantly correlated with the water-soluble calcium concentration of the remineralisation products. Scanning electron microscopy revealed surface precipitates formed by specific remineralisation treatments obfuscated accurate assessment of remineralisation by SMH. It was concluded that TMR is a more appropriate method for analysis of enamel subsurface remineralisation, and that SMH values of remineralised enamel should be interpreted with caution. Using TMR the level of remineralisation (%R) by the different technologies was CPP-ACP/F (31.3 ± 1.4%); CPP-ACP (24.2 ± 1.4%); CaSO4/K2HPO4/F (21.3 ± 1.4%); f-TCP/F (20.9 ± 1.0%); Nano-HA/F (16.3 ± 0.3%); Nano-HA (15.3 ± 0.6%) and F alone control (15.4 ± 1.3%).
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Affiliation(s)
- James R Fernando
- Centre for Oral Health Research, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Glenn D Walker
- Centre for Oral Health Research, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Thomas Kwan-Soo Park
- Centre for Oral Health Research, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Peiyan Shen
- Centre for Oral Health Research, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Yi Yuan
- Centre for Oral Health Research, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Coralie Reynolds
- Centre for Oral Health Research, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Eric C Reynolds
- Centre for Oral Health Research, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Australia.
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Matsuda Y, Jayasinghe RD, Zhong H, Arakawa S, Kanno T. Oral Health Management and Rehabilitation for Patients with Oral Cancer: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10050960. [PMID: 35628095 PMCID: PMC9140416 DOI: 10.3390/healthcare10050960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/29/2022] [Accepted: 05/20/2022] [Indexed: 12/10/2022] Open
Abstract
Surgery is the current first choice for oral cancer treatment. Intensity-modulated radiation therapy, molecular targeted drugs, and immune checkpoint inhibitors are still used as adjuvant therapy for advanced cancer. In addition, postoperative rehabilitation and multidisciplinary treatment have also been developed in recent years. Multidisciplinary team approaches and supportive care in oral cancer treatment reportedly shorten the time to treatment and improve outcomes. Although there is enough evidence confirming the role of oral and maxillofacial surgeons, dentists, and dental hygienists in supportive care in oral cancer treatment, there are very few systematic studies. In particular, oral health management is a concept that encompasses oral function management, oral hygiene management, and oral care during oral cancer treatment. We provide a narrative review focusing on oral health management from a multidisciplinary and supportive care perspective, applicable in oral cancer treatment.
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Affiliation(s)
- Yuhei Matsuda
- Department of Lifetime Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8501, Japan; (H.Z.); (S.A.)
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Japan;
- Correspondence: ; Tel.: +81-3-5803-4649
| | - Ruwan D. Jayasinghe
- Center for Research in Oral Cancer, Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Getambe 20400, Sri Lanka;
| | - Hui Zhong
- Department of Lifetime Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8501, Japan; (H.Z.); (S.A.)
| | - Shinichi Arakawa
- Department of Lifetime Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8501, Japan; (H.Z.); (S.A.)
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Japan;
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Dur MP, Celik N, Seven N. Evaluation of the changes in physical properties and mineral content of enamel exposed to radiation after treating with remineralization agent. Clin Oral Investig 2022; 26:5673-5685. [PMID: 35552532 DOI: 10.1007/s00784-022-04524-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effect of different remineralization agents on the physical properties and elemental content of enamel exposed to radiation. MATERIAL AND METHOD The enamel surfaces of impacted third molar teeth were prepared, and six study groups were created (n = 6). Next, 60 Gy radiation was applied to each group. Between applications, each group except for the control group was treated with a different remineralization agent (sodium fluoride, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), casein phosphopeptide amorphous calcium phosphate with fluorite (CPP-ACFP), bioactive glass, or chitosan). The results were evaluated in terms of pre- and post-radiation values and the difference between the two. The paired-samples t test and analysis of variance test were used in the analysis of normally distributed hardness and roughness values, while Wilcoxon's signed ranks test, and the Kruskal Wallis and Mann-Whitney U tests were used in the analysis of elemental content without normal distribution. RESULTS A statistically significant decrease was observed in microhardness measurements in all groups. Intragroup evaluation revealed a statistically significant difference between the NaF and bioactive glass groups (p < 0.05). No significant difference was observed between the groups' roughness measurements (p < 0.05). Intergroup evaluation of surface roughness revealed a significant difference in the CPP-ACFP and chitosan groups (p < 0.05). Pre- and post-radiation oxygen, magnesium, and potassium levels and Ca/P ratios also differed significantly (p < 0.05). CONCLUSION Radiation caused a statistically significant difference in the microhardness and elemental content of enamel. However, no significant difference was observed in enamel roughness. The applied remineralizing agents have a partial ameliorating effect on the adverse impacts of radiation. CLINICAL RELEVANCE Radiation causes changes in the mechanical properties and elemental content of tooth enamel. Remineralizing agent application is a promising option in reducing the adverse effects of irradiation.
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Affiliation(s)
- Merve Pelin Dur
- Department of Restorative Dentistry, Faculty of Dentistry, Ataturk University, 25240, Erzurum, Turkey.
| | - Neslihan Celik
- Department of Restorative Dentistry, Faculty of Dentistry, Ataturk University, 25240, Erzurum, Turkey
| | - Nilgun Seven
- Department of Restorative Dentistry, Faculty of Dentistry, Ataturk University, 25240, Erzurum, Turkey
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Agarwal D, Purohit B, Ravi P, Priya H, Kumar V. Effectiveness of topical fluorides in prevention of radiation caries in adults: A systematic review and meta- analysis. Oral Oncol 2022; 129:105869. [PMID: 35483157 DOI: 10.1016/j.oraloncology.2022.105869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/21/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Topical fluoride is used for prevention of dental caries. However, its effectiveness and more specifically its formulation and frequency of application in patients undergoing head and neck radiotherapy are still debatable. The aim of this systematic review was to pool the evidence of effectiveness of various topical fluorides in preventing radiation caries or change in bacterial growth in adult patients of head and neck cancer. METHODS Three databases (PubMed and Google Scholar and Cochrane) were searched for randomized controlled or uncontrolled trials or quasi randomised trials published till February 2021. Two independent reviewers screened 346 abstracts finally 14 articles were included in the current systematic review. Primary outcome evaluated was the prevention of radiation caries or change in bacterial growth in saliva. Meta-analysis was performed for the sub groups formed on the basis of fluoride formulations and adjuncts used with it. RESULTS Studies included were highly heterogeneous. Majority of studies found different fluoride formulations to be effective in controlling radiation caries to a variable extent up to 70% depending upon the intervention, patient compliance, rate of attrition and follow up period. Sodium fluoride was the most commonly used caries preventive agent. Meta-analysis showed no significant difference between sodium fluoride formulations and other fluoride agents. Fluoride treatment when incorporated with re-mineralising agent had no significant effect on caries prevention CONCLUSION: Fluoride prevents radiation caries. However, to delineate its exact formulation, dosage or frequency, there is need for more well conducted randomised controlled trials.
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Affiliation(s)
- Deepali Agarwal
- Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
| | - Bharathi Purohit
- Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Ravi
- Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Priya
- Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
| | - Vijay Kumar
- Department of Oral and Maxillofacial Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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8
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Grohe B, Mittler S. Advanced non-fluoride approaches to dental enamel remineralization: The next level in enamel repair management. BIOMATERIALS AND BIOSYSTEMS 2021; 4:100029. [PMID: 36824571 PMCID: PMC9934497 DOI: 10.1016/j.bbiosy.2021.100029] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/22/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022] Open
Abstract
In modern dentistry, a minimally invasive management of early caries lesions or early-stage erosive tooth wear (ETW) with synthetic remineralization systems has become indispensable. In addition to fluoride, which is still the non-plus-ultra in these early caries/ETW treatments, a number of new developments are in the test phase or have already been commercialized. Some of these systems claim that they are comparable or even superior to fluoride in terms of their ability to remineralize enamel. Besides, their use can help avoid some of the risks associated with fluoride and support treatments of patients with a high risk of caries. Two individual non-fluoride systems can be distinguished; intrinsic and extrinsic remineralization approaches. Intrinsic (protein/peptide) systems adsorb to hydroxyapatite crystals/organics located within enamel prisms and accumulate endogenous calcium and phosphate ions from saliva, which ultimately leads to the re-growth of enamel crystals. Extrinsic remineralization systems function on the basis of the external (non-saliva) supply of calcium and phosphate to the crystals to be re-grown. This article, following an introduction into enamel (re)mineralization and fluoride-assisted remineralization, discusses the requirements for non-fluoride remineralization systems, particularly their mechanisms and challenges, and summarizes the findings that underpin the most promising advances in enamel remineralization therapy.
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Affiliation(s)
- Bernd Grohe
- Lawson Health Research Institute, St. Joseph's Hospital, London, ON, N6A 4V2 Canada
| | - Silvia Mittler
- Department of Physics & Astronomy, University of Western Ontario, London, ON, N6A 3K7 Canada
- Department of Chemical and Biochemical Engineering, University of Western Ontario, London, ON, N6A 5B9 Canada
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Kawashita Y, Soutome S, Umeda M, Saito T. Oral management strategies for radiotherapy of head and neck cancer. JAPANESE DENTAL SCIENCE REVIEW 2020; 56:62-67. [PMID: 32123547 PMCID: PMC7037635 DOI: 10.1016/j.jdsr.2020.02.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 01/13/2020] [Accepted: 02/02/2020] [Indexed: 12/11/2022] Open
Abstract
Radiotherapy, often with concomitant chemotherapy, has a significant role in the management of head and neck cancer, however, radiotherapy induces adverse events include oral mucositis, hyposalivation, loss of taste, dental caries, osteoradionecrosis, and trismus, all of which have an impact on patients' quality of life. Therefore, it is necessary to implement oral management strategies prior to the initiation of radiotherapy in patients with head and neck cancer. Since 2014, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) have enumerated the "Principles of Dental Evaluation and Management (DENT-A)" in the section on head and neck cancers, however, oral management was not explained in detail. Oral management has not been achieved a consensus protocol. The aim of this literature is to show that oral management strategy include removal infected teeth before the start of radiotherapy to prevent osteoradionecrosis, oral care for preventing severe oral mucositis to support patient complete radiotherapy during radiotherapy, and prevent of dental caries followed by osteoradionecrosis after radiotherapy.
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Affiliation(s)
- Yumiko Kawashita
- Department of Oral Management Center, Nagasaki University Hospital, Japan
| | - Sakiko Soutome
- Department of Oral Management Center, Nagasaki University Hospital, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Toshiyuki Saito
- Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, Japan
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AlQranei MS, Balhaddad AA, Melo MAS. The burden of root caries: Updated perspectives and advances on management strategies. Gerodontology 2020; 38:136-153. [PMID: 33236462 DOI: 10.1111/ger.12511] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Root caries has gained much attention in the last few years. As the world's population is ageing and people currently tend to retain more teeth compared with older generations, there is an increased prevalence of periodontal disease and gingival recession, which may accelerate the onset of root caries. OBJECTIVE This review aims to summarise recent findings related to the diagnosis, prevention and treatment of root caries. MATERIALS AND METHODS MEDLINE (OVID) and Scopus (Elsevier) searches were performed to identify and discuss articles that address the pathogenicity and clinical management of root caries. RESULTS Root caries is a multifactorial disease. Cariogenic species involved in root caries are less dependent on carbohydrates since collagen degradation inside the dentinal tubules can provide nutrients and microcavities for the invading microorganisms. Furthermore, the root surface has fewer minerals in comparison with enamel, which may accelerate the onset of demineralisation. Root caries could be prevented by patient education, modification of risk factors, and the use of in-office and home remineralisation tools. The use of non-invasive approaches to control root caries is recommended, as the survival rate of root caries restorations is poor. When plaque control is impossible and a deep/large cavity is present, glass ionomer or resin-based restorations can be placed. CONCLUSION The assessment of root carious lesions is critical to determine the lesion activity and the required intervention. Dental practitioners should also be aware of different prevention and treatment approaches to design optimum oral health care for root caries-affected patients.
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Affiliation(s)
- Mohammed S AlQranei
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulrahman A Balhaddad
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mary A S Melo
- Division of Operative Dentistry, Department of General Dentistry, University of Maryland Dental School, Baltimore, MD, USA
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11
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Incidence of new carious lesions and tooth loss in head and neck cancer patients: a retrospective case series from a single unit. Br Dent J 2020; 229:539-543. [PMID: 33097891 DOI: 10.1038/s41415-020-2222-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/20/2020] [Indexed: 11/09/2022]
Abstract
Introduction Radiation-induced xerostomia can result in increased caries incidence, necessitating more dental extractions and a resultant increased risk of debilitating osteoradionecrosis (ORN). Patients undergoing head and neck radiotherapy are routinely treated with a topical preventative regime consisting of fluoride and CPP-ACP (Tooth Mousse). There is limited evidence specifically relating to fluoride prevention regimes in head and neck cancer patients. Other novel remineralising aids using calcium and phosphate have been proposed for use in head and neck cancer patients, but again, there is limited evidence.Aims To retrospectively analyse head and neck cancer patients treated with radiotherapy and placed on a fluoride/CPP-ACP prevention regime at a single institution. To assess the incidence of caries, extractions and ORN.Materials and methods Case records for 95 patients were retrospectively assessed. This involved review of paper and computerised clinical notes, correspondence letters and radiographs.Results The mean number of carious teeth was 6.63 (SD 6.81) and the mean number of extractions was 4.88 (SD 5.84). The teeth most frequently affected by caries and extractions were the mandibular incisors, and 28.4% of patients developed ORN (81.5% of cases occurring in the mandible).Conclusion Development of caries and extraction was a very common event. There is a need for further research into the efficacy of topical prevention regimes.
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Pfister DG, Spencer S, Adelstein D, Adkins D, Anzai Y, Brizel DM, Bruce JY, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Eisele DW, Fenton M, Foote RL, Galloway T, Gillison ML, Haddad RI, Hicks WL, Hitchcock YJ, Jimeno A, Leizman D, Maghami E, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rocco JW, Rodriguez CP, Shah JP, Weber RS, Weinstein G, Witek M, Worden F, Yom SS, Zhen W, Burns JL, Darlow SD. Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:873-898. [DOI: 10.6004/jnccn.2020.0031] [Citation(s) in RCA: 313] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treatment is complex for patients with head and neck (H&N) cancers with specific site of disease, stage, and pathologic findings guiding treatment decision-making. Treatment planning for H&N cancers involves a multidisciplinary team of experts. This article describes supportive care recommendations in the NCCN Guidelines for Head and Neck Cancers, as well as the rationale supporting a new section on imaging recommendations for patients with H&N cancers. This article also describes updates to treatment recommendations for patients with very advanced H&N cancers and salivary gland tumors, specifically systemic therapy recommendations.
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Affiliation(s)
| | | | - David Adelstein
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Douglas Adkins
- 4Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Yoshimi Anzai
- 5Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | | | - David W. Eisele
- 12The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Moon Fenton
- 13The University of Tennessee Health Science Center
| | | | | | | | | | | | | | | | - Debra Leizman
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Bharat B. Mittal
- 22Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - James W. Rocco
- 23The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | - Sue S. Yom
- 27UCSF Helen Diller Family Comprehensive Cancer Center
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Sudradjat H, Meyer F, Loza K, Epple M, Enax J. In Vivo Effects of a Hydroxyapatite-Based Oral Care Gel on the Calcium and Phosphorus Levels of Dental Plaque. Eur J Dent 2020; 14:206-211. [PMID: 32283562 PMCID: PMC7274817 DOI: 10.1055/s-0040-1708456] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Particulate hydroxyapatite (HAP; Ca5(PO4)3(OH)) is a biomimetic oral care ingredient. One mode of action in caries-susceptible individuals may be the adhesion/incorporation of HAP into dental plaque. Therefore, the aim of this in vivo study was to analyze the 3-day effects of a newly developed hydroxyapatite-based oral care gel on the calcium and phosphorus levels within the dental plaque of children. MATERIALS AND METHODS This study was conducted in Kebon Padangan at Bali in Indonesia. Thirty-four children (mean age, 8.9 years; mean DMF-T [decayed, missing, and filled teeth; permanent teeth], 0.6; mean dmft-t [primary teeth] 4.5) were included in the study. The gel was applied thrice for 3 days by an experienced dentist. Dental plaque was collected at baseline and after the study. Levels of calcium and phosphorus of plaque samples were analyzed by energy-dispersive X-ray spectroscopy. STATISTICAL ANALYSIS Medians for both calcium and phosphorus levels were calculated (baseline and 3-day application of HAP-gel). RESULTS The calcium level increased after 3 days of application of the HAP-gel from 0.25 wt% (median) to 0.40 wt% (median), while the phosphorus level increased from 1.17 wt% (median) to 1.41 wt% (median). However, variations in both calcium and phosphorus levels measured in the pooled dental plaque samples were high. CONCLUSION Within the limitations of the study, the 3-day application of the oral HAP-gel in children increased the median of both calcium and phosphorus levels in plaque. Consequently, a positive influence on the remineralization/demineralization process is very likely.
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Affiliation(s)
- Henny Sudradjat
- Department for Dentistry, Health Care Center, Braunschweig, Germany
| | - Frederic Meyer
- Research Department, Dr. Kurt Wolff GmbH & Co. KG, Bielefeld, Germany
| | - Kateryna Loza
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE), University of Duisburg-Essen, Essen, Germany
| | - Matthias Epple
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE), University of Duisburg-Essen, Essen, Germany
| | - Joachim Enax
- Research Department, Dr. Kurt Wolff GmbH & Co. KG, Bielefeld, Germany
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Wu L, Geng K, Gao Q. Effects of different anti-caries procedures on microhardness and micromorphology of irradiated permanent enamel. Dent Mater J 2020; 39:118-125. [PMID: 31582598 DOI: 10.4012/dmj.2018-385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To explore the effects of infiltration resin, casein phosphate polypeptide-amorphous calcium phosphate (CPP-ACP) and fluoride on microhardness and micromorphology of irradiated enamel. Sixty human permanent teeth were mesiodistally sectioned, yielding 120 enamel samples, which randomly divided into 8 groups: G1: blank control; G2: irradiation control; G3: irradiation+fluoride; G4: irradiation+CPP-ACP; G5: irradiation+CPP-ACP+fluoride; G6: irradiation+infiltration resin; G7: irradiation+infiltration resin+fluoride; G8: irradiation+infiltration resin+CPP-ACP. A progressive improvement was observed on the superficial morphology of enamel treated with different anti-caries procedures. The order of microhardness values after irradiation from the highest to the lowest was as follows: G1>G8~G7>G6>G5>G4~G3>G2. CPP-ACP, infiltration resin and fluoride can effectively restore the direct destruction of enamel caused by irradiation and promote the occurrence of remineralization. Infiltration resin and its combined effects with fluoride or CPP-ACP have the most potential anti-caries agent to resist radiation-caries.
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Affiliation(s)
- LiLing Wu
- Department of Stomatology, Zhongshan Hospital Xiamen University.,Center of Stomatology, Xiangya Hospital, Central South University
| | - Kun Geng
- Center of Stomatology, Xiangya Hospital, Central South University
| | - QingPing Gao
- Center of Stomatology, Xiangya Hospital, Central South University
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15
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El‐Rabbany M, Duchnay M, Raziee HR, Zych M, Tenenbaum H, Shah PS, Azarpazhooh A. Interventions for preventing osteoradionecrosis of the jaws in adults receiving head and neck radiotherapy. Cochrane Database Syst Rev 2019; 2019:CD011559. [PMID: 31745986 PMCID: PMC6953365 DOI: 10.1002/14651858.cd011559.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Osteoradionecrosis (ORN) of the jaws is among the most serious oral complications of head and neck cancer radiotherapy, arising from radiation-induced fibro-atrophic tissue injury, manifested by necrosis of osseous tissues and failure to heal, often secondary to operative interventions in the oral cavity. It is associated with considerable morbidity and has important quality of life ramifications. Since ORN is very difficult to treat effectively, preventive measures to limit the onset of this disease are needed; however, the effects of various preventive interventions has not been adequately quantified. OBJECTIVES To assess the effects of interventions for preventing ORN of the jaws in adult patients with head and neck cancer undergoing curative or adjuvant (i.e. non-palliative) radiotherapy. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 5 November 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 10) in the Cochrane Library (searched 5 November 2019), MEDLINE Ovid (1946 to 5 November 2019), Embase Ovid (1980 to 5 November 2019), Allied and Complementary Medicine (AMED) Ovid (1985 to 5 November 2019), Scopus (1966 to 5 November 2019), Proquest Dissertations and Theses International (1861 to 5 November 2019) and Web of Science Conference Proceedings (1990 to 5 November 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) or quasi-RCTs of adult patients 18 years or older with head and neck cancer who had undergone curative or adjuvant radiotherapy to the head and neck, who had received an intervention to prevent the onset of ORN. Eligible patients were those subjected to pre- or post-irradiation dental evaluation. Management of these patients was to be with interventions independent of their cancer therapy, including but not limited to local, systemic, or behavioural interventions. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials from search results, assessed risk of bias, and extracted relevant data for inclusion in the review. Authors of included studies were contacted to request missing data. We used standard methodological procedures expected by Cochrane. MAIN RESULTS Four studies were identified that met pre-determined eligibility criteria, evaluating a total of 342 adults. From the four studies, all assessed as at high risk of bias, three broad interventions were identified that may potentially reduce the risk of ORN development: one study showed no reduction in ORN when using platelet-rich plasma placed in the extraction sockets of prophylactically removed healthy mandibular molar teeth prior to radiotherapy (odds ratio (OR) 3.32, 95% confidence interval (CI) 0.58 to 19.09; one trial, 44 participants; very low-certainty evidence). Another study involved comparing fluoride gel and high-content fluoride toothpaste (1350 parts per million (ppm)) in prevention of post-radiation caries, and found no difference between their use as no cases of ORN were reported (one trial, 220 participants; very low-certainty evidence). The other two studies involved the use of perioperative hyperbaric oxygen (HBO) therapy and antibiotics. One study showed that treatment with HBO caused a reduction in the development of ORN in comparison to patients treated with antibiotics following dental extractions (risk ratio (RR) 0.18, 95% CI 0.43 to 0.76; one trial, 74 participants; very low-certainty evidence). Another study found no difference between combined HBO and antibiotics compared to antibiotics alone prior to dental implant placement (RR 3.00, 95% CI 0.14 to 65.16; one trial, 26 participants; very low-certainty evidence). Adverse effects of the different interventions were not reported clearly or were not important. AUTHORS' CONCLUSIONS Given the suboptimal reporting and inadequate sample sizes of the included studies, evidence regarding the interventions evaluated by the trials included in this review is uncertain. More well-designed RCTs with larger samples are required to make conclusive statements regarding the efficacy of these interventions.
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Affiliation(s)
| | - Michael Duchnay
- University of TorontoFaculty of DentistrySuite 511124 Edward StreetTorontoONCanadaM5G 1G6
| | - Hamid Reza Raziee
- BC Cancer‐SurreyUniversity of British Columbia13750 96th AvenueSurreyBCCanadaV3V 1Z2
| | - Maria Zych
- Faculty of Dentistry, University of TorontoTorontoCanada
| | - Howard Tenenbaum
- University of TorontoFaculty of DentistrySuite 511124 Edward StreetTorontoONCanadaM5G 1G6
| | - Prakeshkumar S Shah
- University of Toronto Mount Sinai HospitalDepartment of Paediatrics and Institute of Health Policy, Management and Evaluation600 University AvenueTorontoONCanadaM5G 1XB
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16
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Wu L, Geng K, Gao Q. Effects of different anti-caries agents on microhardness and superficial microstructure of irradiated permanent dentin: an in vitro study. BMC Oral Health 2019; 19:113. [PMID: 31200708 PMCID: PMC6570839 DOI: 10.1186/s12903-019-0815-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/04/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To compare different anti-caries agents on microhardness and micromorphology of irradiated permanent dentin in vitro, and try to find the most effective agent to prevent radiation-dentin-destruction. METHODS A total of 120 dentin samples were prepared from 60 human teeth and randomly divided into 8 groups (n = 15), [ (1)] blank control [2]; irradiation control [3]; irradiation+ fluoride [4]; irradiation+ casein phosphate polypeptide-amorphous calcium phosphate (CPP-ACP) [5]; irradiation+ CPP-ACP+ fluoride [6]; irradiation+ infiltration resin [7]; irradiation+ infiltration resin+ fluoride [8]; irradiation+ infiltration resin+ CPP-ACP. Seven samples of each groups were chosen randomly for microhardness test and eight for scanning electron microscope observation. RESULTS A decrease of microhardness (P < 0.05) and an obvious morphological change were presented on dentin surface after radiotherapy. After applications of anti-caries agents, the morphological destructions were effectively restored. The infiltration resin plus fluoride group (56.00 ± 4.02 Kg/mm2), infiltration resin plus CPP-ACP group (56.05 ± 3.69 Kg/mm2), infiltration resin group (54.70 ± 4.42Kg/mm2) and CPP-ACP plus fluoride group (53.84 ± 6.23Kg/mm2) had the highest dentin microhardness value after radiotherapy, and no statistically significant difference were found between them. CONCLUSIONS Infiltration resin, CPP-ACP, fluoride and their pairwise combination can effectively prevent radiation-dentin-destruction. Among them, infiltration resin with CPP-ACP, infiltration resin with fluoride, CPP-ACP with fluoride, and infiltration resin have the most protective effects on irradiation-dentin-destructions.
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Affiliation(s)
- LiLing Wu
- Center of Stomatology, Xiangya Hospital Central South University, Changsha, 410008 Hunan Province China
- Department of Stomatology, ZhongShan Hospital Xiamen University, Xiamen, 361004 China
| | - Kun Geng
- Center of Stomatology, Xiangya Hospital Central South University, Changsha, 410008 Hunan Province China
| | - QingPing Gao
- Center of Stomatology, Xiangya Hospital Central South University, Changsha, 410008 Hunan Province China
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17
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Carious lesion remineralizing potential of fluoride- and calcium-containing toothpastes: A laboratory study. J Am Dent Assoc 2019; 150:345-351. [PMID: 30902337 DOI: 10.1016/j.adaj.2018.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The authors conducted a laboratory study to determine the carious lesion remineralization and fluoridation potential of fluoride (F)- and calcium-containing toothpastes. METHODS The authors created early carious lesions in bovine enamel specimens and assigned them to 7 treatment groups on the basis of their surface Vickers microhardness: Clinpro Tooth Crème (Clinpro) (3M ESPE), CTx4 Gel 1100 (CTx4) (Oral Biotech), Enamelon Fluoride Toothpaste (Enamelon) (Premier Dental), MI Paste ONE (MI-One) (GC America), Crest Cavity Protection Toothpaste (Crest) (Procter & Gamble), and 2 F-dose controls (low F, high F). The authors pH cycled the specimens for 10 days by using an established model, determined changes in surface microhardness, calculated percentage of surface microhardness recovery (%SMHr; primary outcome variable), and measured enamel F uptake (EFU). The authors used a 1-way analysis of variance for data analysis. RESULTS Study results showed an F-dose response for both %SMHr (low-F control: mean, 9.8; 95% confidence interval [CI], 5.7 to 13.8); Crest: mean, 26.2; CI, 21.8 to 30.6; high-F control: mean, 33.5; CI, 29.4 to 37.5) and EFU (low-F control: mean, 47; CI, 12 to 83; Crest: mean, 225; CI, 189 to 260; high-F control: mean, 307; CI, 271 to 342; all micrograms of F per cubic centimeter). For %SMHr, Clinpro (mean, 26.5; CI, 22.5 to 30.6) and CTx4 (mean, 27.3; CI, 23.1 to 31.5) were similar to Crest, all being superior to Enamelon (mean, 15.6; CI, 11.6 to 19.7), which was superior to MI-One (mean, 4.3; CI, 0.3 to 8.3). For EFU, there were no differences between Clinpro (mean, 189; CI, 153 to 224), CTx4 (mean, 177; CI, 142 to 213), Enamelon (mean, 196; CI, 161 to 232), and Crest, all being superior to MI-One (mean, 66; CI, 30 to 102). CONCLUSIONS This study's results failed to show superior remineralizing efficacy of any of the toothpastes compared with those of a calcium-free F toothpaste, with 2 of the 4 toothpastes being inferior. Clinical testing will be required to establish conclusive evidence. PRACTICAL IMPLICATIONS Clinicians should be aware of the remineralizing potential of new anticaries products.
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18
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Allen PF, Da Mata C, Hayes M. Minimal intervention dentistry for partially dentate older adults. Gerodontology 2019; 36:92-98. [DOI: 10.1111/ger.12389] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Martina Hayes
- Cork University Dental School & Hospital, Wilton Cork Ireland
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19
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Sim CPC, Walker GD, Manton DJ, Soong YL, Wee JTS, Adams GG, Reynolds EC. Anticariogenic efficacy of a saliva biomimetic in head-and-neck cancer patients undergoing radiotherapy. Aust Dent J 2018; 64:47-54. [DOI: 10.1111/adj.12658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2018] [Indexed: 01/04/2023]
Affiliation(s)
- CPC Sim
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Victoria Australia
- Department of Restorative Dentistry; National Dental Centre; Singapore
| | - GD Walker
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Victoria Australia
| | - DJ Manton
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Victoria Australia
| | - YL Soong
- Division of Radiation Oncology; National Cancer Centre; Singapore
| | - JTS Wee
- Division of Radiation Oncology; National Cancer Centre; Singapore
| | - GG Adams
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Victoria Australia
| | - EC Reynolds
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Victoria Australia
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20
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Philip N. State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management. Caries Res 2018; 53:284-295. [PMID: 30296788 DOI: 10.1159/000493031] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/11/2018] [Indexed: 12/17/2022] Open
Abstract
The principles of minimally invasive dentistry clearly dictate the need for clinically effective measures to remineralize early enamel caries lesions. While fluoride-mediated remineralization is the cornerstone of current caries management philosophies, a number of new remineralization strategies have been commercialized or are under development that claim to promote deeper remineralization of lesions, reduce the potential risks associated with high-fluoride oral care products, and facilitate caries control over a lifetime. These non-fluoride remineralizing systems can be broadly categorized into biomimetic enamel regenerative technologies and the approaches that repair caries lesions by enhancing fluoride efficacy. This paper discusses the rationale for non-fluoride remineralization and the mechanism of action, challenges, and evidence behind some of the most promising advances in enamel remineralization therapies.
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Affiliation(s)
- Nebu Philip
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia,
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21
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Shen P, Walker GD, Yuan Y, Reynolds C, Stanton DP, Fernando JR, Reynolds EC. Importance of bioavailable calcium in fluoride dentifrices for enamel remineralization. J Dent 2018; 78:59-64. [PMID: 30099066 DOI: 10.1016/j.jdent.2018.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To compare remineralization of enamel subsurface lesions by fluoride dentifrices with added calcium in a double-blind, randomized, cross-over, in situ study. METHODS Human enamel with subsurface lesions were prepared and inserted into intra-oral appliances worn by volunteers. A slurry (1 g toothpaste/4 ml H2O) was rinsed for 60 s, 4 times per day for 14 days. Seven toothpastes were tested: (i) 1450 ppm F (NaF), (ii) 5000 ppm F (NaF), (iii) 1450 ppm F (MFP) with calcium sodium phosphosilicate (CSP), (iv) 1450 ppm F (MFP) with CaCO3/Arg, (v) 1150 ppm F (SnF2) with amorphous calcium phosphate (ACP), (vi) 1100 ppm F (NaF) with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and (vii) 5000 ppm F (NaF) with functionalized tri-calcium phosphate (TCP). Total (acid soluble) and bioavailable (water soluble) calcium, inorganic phosphate and fluoride levels of the dentifrices were measured using ion chromatography (F/MFP) and spectrophotometry (Ca and inorganic phosphate). Enamel lesion mineral content was measured using transverse microradiography. Data were statistically analysed using a linear mixed model. RESULTS All calcium and fluoride containing toothpastes released > 90% of bioavailable fluoride and were superior to the respective fluoride alone toothpastes in remineralization of enamel subsurface lesions. The level of remineralization followed the order: CPP-ACP/1l00 ppm F > ACP/1150 ppm F = TCP/5000 ppm F > 5000 ppm F = CaCO3/Arg/1450 ppm F = CSP/1450 ppm F > 1450 ppm F. Bioavailable calcium levels significantly correlated with enhanced remineralization of enamel subsurface lesions. CONCLUSIONS Bioavailable calcium in fluoride dentifrices enhanced remineralization of enamel subsurface lesions.
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Affiliation(s)
- Peiyan Shen
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Victoria, Australia
| | - Glenn D Walker
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Victoria, Australia
| | - Yi Yuan
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Victoria, Australia
| | - Coralie Reynolds
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Victoria, Australia
| | - David P Stanton
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Victoria, Australia
| | - James R Fernando
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Victoria, Australia
| | - Eric C Reynolds
- Oral Health Cooperative Research Centre, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Victoria, Australia.
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22
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Meyer F, Amaechi BT, Fabritius HO, Enax J. Overview of Calcium Phosphates used in Biomimetic Oral Care. Open Dent J 2018; 12:406-423. [PMID: 29988215 PMCID: PMC5997847 DOI: 10.2174/1874210601812010406] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/23/2018] [Accepted: 05/14/2018] [Indexed: 11/24/2022] Open
Abstract
Background: The use of biomimetic agents is an emerging field in modern oral care. Promising biomimetic substances for such applications are calcium phosphates, because their chemical composition is very similar to that of the mineral phase in human teeth, especially of natural enamel. Examples for their application include the remineralization of early caries lesions and repair of small enamel defects. Objective: This review provides an interdisciplinary view on calcium phosphates and their applications in biomimetic oral care. The aim of this work is to give an overview of in vivo and in situ studies comparing several calcium phosphates in preventive dentistry that can be used as a knowledge base for the development of innovative alternative oral care concepts. Methods: Books, reviews, and original research papers with a focus on in vivo and in situ studies were included. The databases PubMed® and SciFinder® were used for literature search. Calcium phosphates that are frequently utilized in oral care products are covered in this review and were used as search terms alone and together with the following key words: in vivo, in situ, caries, clinical study, and remineralization. From 13,470 studies found, 35 studies complied with the inclusion criteria and were used for this review. Results: Published in vivo and in situ studies demonstrate calcium phosphates’ potential in enamel remineralization. However, more studies are needed to further substantiate existing results and to extend and refine the application of calcium phosphates in modern oral care. Conclusion: Calcium phosphates represent an innovative biomimetic approach for daily oral care because of their high similarity to natural enamel that will broaden the range of future treatments in preventive dentistry.
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Affiliation(s)
- Frederic Meyer
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611 Bielefeld, Germany
| | - Bennett T Amaechi
- Department of Comprehensive Dentistry, University of Texas Health Science Center, 703 Floyd Curl Drive, San Antonio, Texas 78229-3900, USA
| | - Helge-Otto Fabritius
- Max-Planck-Institut für Eisenforschung GmbH, Microstructure Physics and Alloy Design, Max-Planck-Straße 1, 40237 Duesseldorf, Germany
| | - Joachim Enax
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611 Bielefeld, Germany
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23
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Sim C, Soong YL, Pang E, Lim C, Walker GD, Manton DJ, Reynolds EC, Wee J. Xerostomia, salivary characteristics and gland volumes following intensity-modulated radiotherapy for nasopharyngeal carcinoma: a two-year follow up. Aust Dent J 2018; 63:217-223. [PMID: 29569726 DOI: 10.1111/adj.12608] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate changes in xerostomia status, salivary characteristics and gland volumes 2 years following radiotherapy in nasopharyngeal carcinoma patients. METHODS Xerostomia scores, salivary flow rates, pH and buffering capacity were measured at pre-radiotherapy, mid-radiotherapy, 2 weeks, 3 months and 2 years post-radiotherapy. Salivary gland volumes and their correlation with radiation dose were also assessed. RESULTS Mean radiation dose to oral cavity, parotid and submandibular glands (SMG) was 44.5, 65.0 and 38.6 Gy respectively. Parotid and SMG volumes decreased 33% at 3 months post-radiotherapy; volumes at 2 years post-radiotherapy were 84% and 51% of pre-radiotherapy levels, respectively. Correlations were observed between parotid gland volume per cent reduction and its radiation dose and between resting salivary flow rate reduction and post-radiotherapy/pre-radiotherapy SMG volume ratio. Salivary flow rates and resting saliva pH remained significantly low at 2 years post-radiotherapy (both flow rates, P = 0.001; resting saliva pH, P = 0.005). Similarly, xerostomia scores remained significantly higher compared with pre-radiotherapy levels. CONCLUSIONS Submandibular gland volumetric shrinkage persisted 2 years after radiotherapy. Xerostomia scores remained significantly higher, and salivary flow rates and resting saliva pH remained significantly lower, suggesting that study participants were still at risk for hyposalivation-related oral diseases.
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Affiliation(s)
- Cpc Sim
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Oral Health Cooperative Research Centre, Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - Y L Soong
- Duke-NUS Medical School, Singapore, Singapore.,Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Epp Pang
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - C Lim
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - G D Walker
- Oral Health Cooperative Research Centre, Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - D J Manton
- Oral Health Cooperative Research Centre, Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - E C Reynolds
- Oral Health Cooperative Research Centre, Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - Jts Wee
- Duke-NUS Medical School, Singapore, Singapore.,Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Cai J, Palamara JEA, Manton DJ, Burrow MF. Status and progress of treatment methods for root caries in the last decade: a literature review. Aust Dent J 2017; 63:34-54. [DOI: 10.1111/adj.12550] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 12/26/2022]
Affiliation(s)
- J Cai
- Melbourne Dental School; The University of Melbourne; Melbourne Victoria Australia
| | - JEA Palamara
- Melbourne Dental School; The University of Melbourne; Melbourne Victoria Australia
| | - DJ Manton
- Melbourne Dental School; The University of Melbourne; Melbourne Victoria Australia
| | - MF Burrow
- Melbourne Dental School; The University of Melbourne; Melbourne Victoria Australia
- Faculty of Dentistry; The University of Hong Kong; Hong Kong China
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25
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Restorative dentistry and oral rehabilitation: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology & Otology 2017; 130:S41-S44. [PMID: 27841112 PMCID: PMC4873898 DOI: 10.1017/s0022215116000414] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK and provides recommendations on the pre-treatment oral and dental assessment, during and after treatment and oral rehabilitation. Restorative dentists are core members of the multidisciplinary team treating head and neck cancer patients, involved from the treatment planning phase through to long-term rehabilitation.
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26
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Is it Sjögren's syndrome or burning mouth syndrome? Distinct pathoses with similar oral symptoms. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:482-495. [PMID: 28283095 DOI: 10.1016/j.oooo.2017.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 12/17/2022]
Abstract
Sjögren's syndrome (SS) and burning mouth syndrome (BMS) typically occur in postmenopausal women. Although these conditions have significantly different etiopathogeneses, patients with SS or BMS often present with analogous oral complaints. The similarities between the two conditions have led to considerable confusion on the part of medical and dental practitioners, and those with BMS or SS often wait years to receive a diagnosis. Therefore, it is imperative for clinicians to understand the characteristic subjective and objective features of each disease and how these can be used to distinguish them. This review will discuss the proposed etiology, clinical manifestations, histopathology, diagnostic criteria, and patient management of SS and BMS. We also identify key differences between the two pathoses that aid in establishing the correct diagnosis. Recognition of the defining features of each condition will lead to reduced time to diagnosis and improved patient management for these poorly understood conditions.
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Shen P, Bagheri R, Walker GD, Yuan Y, Stanton DP, Reynolds C, Reynolds EC. Effect of calcium phosphate addition to fluoride containing dental varnishes on enamel demineralization. Aust Dent J 2016; 61:357-65. [DOI: 10.1111/adj.12385] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 12/11/2022]
Affiliation(s)
- P Shen
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Carlton Melbourne Victoria Australia
| | - R Bagheri
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Carlton Melbourne Victoria Australia
- Department of Dental Materials and Biomaterials Research Center; Shiraz Dental School; Shiraz University of Medical Sciences; Shiraz Iran
| | - GD Walker
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Carlton Melbourne Victoria Australia
| | - Y Yuan
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Carlton Melbourne Victoria Australia
| | - DP Stanton
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Carlton Melbourne Victoria Australia
| | - C Reynolds
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Carlton Melbourne Victoria Australia
| | - EC Reynolds
- Oral Health Cooperative Research Centre; Melbourne Dental School; Bio21 Institute; The University of Melbourne; Carlton Melbourne Victoria Australia
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Gupta N, Pal M, Rawat S, Grewal MS, Garg H, Chauhan D, Ahlawat P, Tandon S, Khurana R, Pahuja AK, Mayank M, Devnani B. Radiation-induced dental caries, prevention and treatment - A systematic review. Natl J Maxillofac Surg 2016; 6:160-6. [PMID: 27390489 PMCID: PMC4922225 DOI: 10.4103/0975-5950.183870] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Treatment of head and neck cancers (HNCs) involves radiotherapy. Patients undergoing radiotherapy for HNCs are prone to dental complications. Radiotherapy to the head and neck region causes xerostomia and salivary gland dysfunction which dramatically increases the risk of dental caries and its sequelae. Radiation therapy (RT) also affects the dental hard tissues increasing their susceptibility to demineralization following RT. Postradiation caries is a rapidly progressing and highly destructive type of dental caries. Radiation-related caries and other dental hard tissue changes can appear within the first 3 months following RT. Hence, every effort should be focused on prevention to manage patients with severe caries. This can be accomplished through good preoperative dental treatment, frequent dental evaluation and treatment after RT (with the exception of extractions), and consistent home care that includes self-applied fluoride. Restorative management of radiation caries can be challenging. The restorative dentist must consider the altered dental substrate and a hostile oral environment when selecting restorative materials. Radiation-induced changes in enamel and dentine may compromise bonding of adhesive materials. Consequently, glass ionomer cements have proved to be a better alternative to composite resins in irradiated patients. Counseling of patients before and after radiotherapy can be done to make them aware of the complications of radiotherapy and thus can help in preventing them.
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Affiliation(s)
- Nishtha Gupta
- Department of Conservative Dentistry and Endodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
| | - Manoj Pal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sheh Rawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Mandeep S Grewal
- Department of Conservative Dentistry and Endodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
| | - Himani Garg
- Department of Conservative Dentistry and Endodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
| | - Deepika Chauhan
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ruparna Khurana
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anjali K Pahuja
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Mayur Mayank
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Bharti Devnani
- Department of Radiation Oncology, SGPGI, Lucknow, Uttar Pradesh, India
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Abou Nader C, Pellen F, Loutfi H, Mansour R, Le Jeune B, Le Brun G, Abboud M. Early diagnosis of teeth erosion using polarized laser speckle imaging. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:71103. [PMID: 26720050 DOI: 10.1117/1.jbo.21.7.071103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/10/2015] [Indexed: 06/05/2023]
Abstract
Dental erosion starts with a chemical attack on dental tissue causing tooth demineralization, altering the tooth structure and making it more sensitive to mechanical erosion. Medical diagnosis of dental erosion is commonly achieved through a visual inspection by the dentist during dental checkups and is therefore highly dependent on the operator's experience. The detection of this disease at preliminary stages is important since, once the damage is done, cares become more complicated. We investigate the difference in light-scattering properties between healthy and eroded teeth. A change in light-scattering properties is observed and a transition from volume to surface backscattering is detected by means of polarized laser speckle imaging as teeth undergo acid etching, suggesting an increase in enamel surface roughness.
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Affiliation(s)
- Christelle Abou Nader
- Saint Joseph University, Physics Department, Faculty of Science, UR TVA, B.P. 11-514-Riad El Solh, Beirut 1107 2050, LebanonbUniversité de Bretagne Occidentale, UEB, EA 938 Laboratoire de Spectrométrie et Optique Laser, IBSAM, 6 avenue le Gorgeu, C.S. 938
| | - Fabrice Pellen
- Université de Bretagne Occidentale, UEB, EA 938 Laboratoire de Spectrométrie et Optique Laser, IBSAM, 6 avenue le Gorgeu, C.S. 93837, 29238 Brest Cedex 3, France
| | - Hadi Loutfi
- Saint Joseph University, Physics Department, Faculty of Science, UR TVA, B.P. 11-514-Riad El Solh, Beirut 1107 2050, Lebanon
| | - Rassoul Mansour
- Saint Joseph University, Physics Department, Faculty of Science, UR TVA, B.P. 11-514-Riad El Solh, Beirut 1107 2050, Lebanon
| | - Bernard Le Jeune
- Université de Bretagne Occidentale, UEB, EA 938 Laboratoire de Spectrométrie et Optique Laser, IBSAM, 6 avenue le Gorgeu, C.S. 93837, 29238 Brest Cedex 3, France
| | - Guy Le Brun
- Université de Bretagne Occidentale, UEB, EA 938 Laboratoire de Spectrométrie et Optique Laser, IBSAM, 6 avenue le Gorgeu, C.S. 93837, 29238 Brest Cedex 3, France
| | - Marie Abboud
- Saint Joseph University, Physics Department, Faculty of Science, UR TVA, B.P. 11-514-Riad El Solh, Beirut 1107 2050, Lebanon
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Cohen EEW, LaMonte SJ, Erb NL, Beckman KL, Sadeghi N, Hutcheson KA, Stubblefield MD, Abbott DM, Fisher PS, Stein KD, Lyman GH, Pratt-Chapman ML. American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA Cancer J Clin 2016; 66:203-39. [PMID: 27002678 DOI: 10.3322/caac.21343] [Citation(s) in RCA: 387] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society.
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Affiliation(s)
- Ezra E W Cohen
- Medical Oncologist, Moores Cancer Center, University of California at San Diego, La Jolla, CA
| | - Samuel J LaMonte
- Retired Head and Neck Surgeon, Former Associate Professor of Otolaryngology and Head and Neck Surgery, Louisiana State University Health and Science Center, New Orleans, LA
| | - Nicole L Erb
- Program Manager, National Cancer Survivorship Resource Center, American Cancer Society, Atlanta, GA
| | - Kerry L Beckman
- Research Analyst-Survivorship, American Cancer Society, Atlanta, GA
| | - Nader Sadeghi
- Professor of Surgery, Division of Otolaryngology-Head and Neck Cancer Surgery, and Director of Head and Neck Surgical Oncology, George Washington University, Washington, DC
| | - Katherine A Hutcheson
- Associate Professor, Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael D Stubblefield
- Medical Director for Cancer Rehabilitation, Kessler Institute for Rehabilitation, West Orange, NJ
| | - Dennis M Abbott
- Chief Executive Officer, Dental Oncology Professionals, Garland, TX
| | - Penelope S Fisher
- Clinical Instructor of Otolaryngology and Nurse, Miller School of Medicine, Department of Otolaryngology, Division of Head and Neck Surgery, University of Miami, Miami, FL
| | - Kevin D Stein
- Vice President, Behavioral Research, and Director, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Gary H Lyman
- Co-Director, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, and Professor of Medicine, University of Washington School of Medicine, Seattle, WA
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Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Xerostomia and trismus (Part 2). Literature review and consensus statement. Crit Rev Oncol Hematol 2016; 102:47-54. [PMID: 27061883 DOI: 10.1016/j.critrevonc.2016.03.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 03/09/2016] [Indexed: 01/28/2023] Open
Abstract
Radiotherapy alone or in combination with chemotherapy and/or surgery is a well-known radical treatment for head and neck cancer patients. Nevertheless acute side effects (such as moist desquamation, skin erythema, loss of taste, mucositis etc.) and in particular late toxicities (osteoradionecrosis, xerostomia, trismus, radiation caries etc.) are often debilitating and underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met in Milan with the aim of reaching a consensus on a clinical definition and management of these toxicities. The Delphi Appropriateness method was used for this consensus and external experts evaluated the conclusions. The paper contains 20 clusters of statements about the clinical definition and management of stomatological issues that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecrosis (10 clusters of statements), whereas this second part deals with trismus and xerostomia (10 clusters of statements).
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Zero DT, Brennan MT, Daniels TE, Papas A, Stewart C, Pinto A, Al-Hashimi I, Navazesh M, Rhodus N, Sciubba J, Singh M, Wu AJ, Frantsve-Hawley J, Tracy S, Fox PC, Ford TL, Cohen S, Vivino FB, Hammitt KM. Clinical practice guidelines for oral management of Sjögren disease: Dental caries prevention. J Am Dent Assoc 2016; 147:295-305. [PMID: 26762707 DOI: 10.1016/j.adaj.2015.11.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Salivary dysfunction in Sjögren disease can lead to serious and costly oral health complications. Clinical practice guidelines for caries prevention in Sjögren disease were developed to improve quality and consistency of care. METHODS A national panel of experts devised clinical questions in a Population, Intervention, Comparison, Outcomes format and included use of fluoride, salivary stimulants, antimicrobial agents, and nonfluoride remineralizing agents. The panel conducted a systematic search of the literature according to pre-established parameters. At least 2 members extracted the data, and the panel rated the strength of the recommendations by using a variation of grading of recommendations, assessment, development, and evaluation. After a Delphi consensus panel was conducted, the experts finalized the recommendations, with a minimum of 75% agreement required. RESULTS Final recommendations for patients with Sjögren disease with dry mouth were as follows: topical fluoride should be used in all patients (strong); although no study results link improved salivary flow to caries prevention, the oral health community generally accepts that increasing saliva may contribute to decreased caries incidence, so increasing saliva through gustatory, masticatory, or pharmaceutical stimulation may be considered (weak); chlorhexidine administered as varnish, gel, or rinse may be considered (weak); and nonfluoride remineralizing agents may be considered as an adjunct therapy (moderate). CONCLUSIONS AND PRACTICAL IMPLICATIONS The incidence of caries in patients with Sjögren disease can be reduced with the use of topical fluoride and other preventive strategies.
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Buglione M, Cavagnini R, Di Rosario F, Sottocornola L, Maddalo M, Vassalli L, Grisanti S, Salgarello S, Orlandi E, Paganelli C, Majorana A, Gastaldi G, Bossi P, Berruti A, Pavanato G, Nicolai P, Maroldi R, 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. [DOI: 10.1016/j.critrevonc.2015.08.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 08/05/2015] [Indexed: 11/29/2022] Open
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Katsura K, Soga M, Abe E, Matsuyama H, Aoyama H, Hayashi T. Effects of casein phosphopeptide–amorphous calcium phosphate with sodium fluoride on root surface conditions in head and neck radiotherapy patients. Oral Radiol 2015. [DOI: 10.1007/s11282-015-0218-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Deng J, Jackson L, Epstein JB, Migliorati CA, Murphy BA. Dental demineralization and caries in patients with head and neck cancer. Oral Oncol 2015. [PMID: 26198979 DOI: 10.1016/j.oraloncology.2015.06.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Concurrent chemoradiation (CCR) therapy is a standard treatment for patients with locally advanced head and neck cancer (HNC). It is well documented that CCR causes profound acute and late toxicities. Xerostomia (the symptom of dry mouth) and hyposalivation (decreased salivary flow) are among the most common treatment side effects in this cohort of patients during and following treatment. They are the result of radiation-induced damage to the salivary glands. Patients with chronic hyposalivation are at risk for demineralization and dental cavitation (dental caries), often presenting as a severe form of rapidly developing decay that results in loss of dentition. Usual post-radiation oral care which includes the use of fluoride, may decrease, but does not eliminate dental caries associated with radiation-induced hyposalivation. The authors conducted a narrative literature review regarding dental caries in HNC population based on MEDLINE, PubMed, CLNAHL, Cochrane database, EMBASE, and PsycINFO from 1985 to 2014. Primary search terms included head and/or neck cancer, dental caries, dental decay, risk factor, physical symptom, physical sequellea, body image, quality of life, measurement, assessment, cost, prevention, and treatment. The authors also reviewed information from National Institute of Dental and Craniofacial Research (NIDCR), American Dental Association (ADA), and other related healthcare professional association web sites. This literature review focuses on critical issues related to dental caries in patients with HNC: potential mechanisms and contributing factors, clinical assessment, physical sequellea, negative impact on body image and quality of life, potential preventative strategies, and recommendations for practice and research in this area.
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Affiliation(s)
- Jie Deng
- School of Nursing, Vanderbilt University, Nashville, TN, United States.
| | - Leanne Jackson
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, United States
| | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles Ca and Division of Otolaryngology and Head and Neck Surgery, City of Hope National Medical Center, Duarte, CA, United States
| | - Cesar A Migliorati
- Department of Diagnostic Sciences and Oral Medicine, College of Dentistry, University of Tennessee Health Sciences Center, Memphis, TN, United States
| | - Barbara A Murphy
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, United States
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Wierichs RJ, Meyer-Lueckel H. Systematic review on noninvasive treatment of root caries lesions. J Dent Res 2014; 94:261-71. [PMID: 25398366 DOI: 10.1177/0022034514557330] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present systematic review critically summarizes results of clinical studies investigating chemical agents to reduce initiation or inactivation of root caries lesions (RCLs). Outcomes were DMFRS/DFRS (decayed, missing, filled root surfaces), surface texture (hard/soft), and/or RCI (root caries index). Three electronic databases were screened for studies from 1947 to 2014. Cross-referencing was used to further identify articles. Article selection and data abstraction were done in duplicate. Languages were restricted to English and German. Mean differences (MD) were calculated for changes in DMFRS/DFRS. Risk ratios (RR) were calculated for changes in surface texture and RCI in a random effects model. Thirty-four articles with 1 or more agents were included; they reported 30 studies with 10,136 patients who were 20 to 101 y old; and they analyzed 28 chemical agents (alone or in combination). Eleven studies investigated dentifrices, 10 rinses, 8 varnishes, 3 solutions, 3 gels, and 2 ozone applications. Meta-analyses revealed that dentifrices containing 5,000 ppm F(-) (RR = 0.49; 95% confidence interval [95% CI] = 0.42, 0.57; high level of evidence) or 1.5% arginine plus 1,450 ppm F(-) (RR = 0.79; 95% CI = 0.64, 0.98; very low level) are more effective in inactivating RCLs than dentifrices containing 1,100 to 1,450 ppm F(-). Self-applied AmF/SnF2-containing dentifrice and rinse decreased the initiation of RCLs when compared with NaF products (standardized MD = 0.15; 95% CI = -0.22, 0.52; low level). Patients rinsing with a mouth rinse containing 225 to 900 ppm F(-) revealed a significantly reduced DMFRS/DFRS (MD = -0.18; 95% CI = -0.35, -0.01; low level) when compared with a placebo rinse. Significantly reduced RCI was found for CHX (MD = -0.67; 95% CI = -1.01, -0.32; very low level) as well as SDF (MD = -0.33; 95% CI = -0.39, -0.28; very low level) when compared with placebo varnish. Regular use of dentifrices containing 5,000 ppm F(-) and quarterly professionally applied CHX or SDF varnishes seem to be efficacious to decrease progression and initiation of root caries, respectively. However, this conclusion is based on only very few well-conducted randomized controlled trials.
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Affiliation(s)
- R J Wierichs
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - H Meyer-Lueckel
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
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Sim CPC, Wee J, Xu Y, Cheung YB, Soong YL, Manton DJ. Anti-caries effect of CPP-ACP in irradiated nasopharyngeal carcinoma patients. Clin Oral Investig 2014; 19:1005-11. [PMID: 25261399 DOI: 10.1007/s00784-014-1318-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 09/09/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on caries progression in irradiated nasopharyngeal carcinoma (NPC) patients. METHODS Twenty-one males and three females (median age, 50 years) were randomized into two groups before radiotherapy. Subjects had at least eight teeth after oral health clearance. The test group used 0.4 % stannous fluoride gel and a crème containing 10 % CPP-ACP daily; the control group used a similar crème without CPP-ACP and otherwise identical care. Subjects applied the crème three times daily and fluoride gel once daily. Caries status, saliva and plaque parameters were measured pre-radiotherapy, at 2 weeks and 3 months post-radiotherapy. RESULTS Baseline International Caries Detection and Assessment System (ICDAS) scores were 0-1126 surfaces (93.9 %), 1-28 surfaces (2.3 %), 2-40 surfaces (3.3 %) and 3-6 surfaces (0.5 %) for the control and 0-1186 surfaces (95.6 %), 1-31 surfaces (2.5 %), 2-15 surfaces (1.2 %) and 3-8 surfaces (0.7 %) for the test group. Twenty-two subjects returned at 3 months post-radiotherapy with reduced plaque pH, salivary flow, pH and buffering capacity. Nine test and 8 control subjects developed 32 and 59 new caries lesions, respectively. Test subjects showed lower caries progression than the controls: all surfaces (OR 0.51, 95 % CI 0.17∼1.59), occlusal (OR 0.20, 95 % CI 0.03∼1.29) and smooth surfaces (OR 0.61, 95 % CI 0.16∼2.38). The difference was not statistically significant. CONCLUSION Application of CPP-ACP did not significantly reduce caries progression in NPC patients in the first 3 months after radiotherapy as compared to controls. CLINICAL RELEVANCE Adjunct use of CPP-ACP with stannous fluoride gel in irradiated NPC patients gave comparable results compared to stannous fluoride gel alone in reducing caries progression.
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Affiliation(s)
- Christina P C Sim
- Department of Restorative Dentistry, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore, 168938, Singapore,
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Saliva substitutes in combination with high-fluoride gel on dentin remineralization. Clin Oral Investig 2014; 19:289-97. [PMID: 24872322 DOI: 10.1007/s00784-014-1264-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 05/16/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to determine whether the application of a high-fluoride gel could increase the remineralization of subsurface dentin lesions stored in saliva substitutes. MATERIALS AND METHODS Demineralized bovine dentin specimens were stored in mineral water (W), Glandosane (G), or modified Saliva natura (SN). Different treatments were applied twice daily: no treatment, Elmex sensitive mouth rinse (E), ProSchmelz gel (P), Duraphat toothpaste (D), ED, PD, and EPD. Differences in mineral loss were evaluated by transversal microradiography after 2 and 5 weeks. RESULTS The treatments with E, D, and ED inhibited the mineral loss induced by G and enabled some mineral gain. ProSchmelz was not able to inhibit the demineralizing effect of G. This high-fluoride gel induced an erosive mineral loss in combination with G. The use of ProSchmelz in combination or not with other fluoride products did not increase remineralization of specimens stored in SN or W (p > 0.05). ProSchmelz resulted in an erosion of the specimens stored in W and revealed a lower mineralized surface layer of specimens stored in SN. CONCLUSION Topical application of high-fluoride gel reduced the mineral loss induced by G but resulted in an erosion of specimens' surface. In addition, ProSchmelz did not demonstrate beneficial effects in combination with SN on subsurface dentin lesion remineralization. CLINICAL RELEVANCE Within the limitations of an in vitro study, it was concluded that the application of a high-fluoride gel did not promote additional effects on remineralization of subsurface dentin lesions in combination with saliva substitutes when compared to products with lower fluoride concentration.
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Singh M, Papas A, Vollmer W, Bader J, Laws R, Maupome G, Snyder J, Blanchard P. Predictors of coronal caries progression in adults: results from the Prevention of Adult Caries Study. Community Dent Oral Epidemiol 2013; 41:558-64. [PMID: 23834229 DOI: 10.1111/cdoe.12059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 06/08/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This secondary analysis of data from the Prevention of Adult Caries Study (PACS) assesses risk factors for progression of coronal caries. METHODS Participants (n = 983) were adults at increased caries risk with at least one cavitated and one noncavitated lesions who were enrolled in a randomized clinical trial to test the effect of a 10% w/v chlorhexidine varnish coating on caries progression. Calibrated examiners scored tooth surfaces using a modified International Caries Detection and Assessment System (ICDAS) classification at baseline and at 7 and 13 months postrandomization. Potential baseline predictors of caries risk were used in adjusted negative binomial regression models to predict net D2FS increment and in linear regression models to predict the rank-normalized net D12FS increment. RESULTS Mean (SD) D2FS and D12FS increments were and 2.4 (3.1) and 2.1 (6.9), respectively. In multivariate analyses, two or more baseline D2 lesions, consumption of acidic drinks, and increasing age were all significantly associated with increased D2FS and D12FS risk. Daily flossing also was associated with increased D2FS risk. More frequent dental care at baseline was associated with significantly decreased caries risk for both increments. CONCLUSIONS The general concordance of risk factors in the D12FS and D2FS models lends support to the hypothesis that the D1 increment is an intermediate stage in the progression to fully cavitated lesions.
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Affiliation(s)
- Mabi Singh
- Department of Oral Pathology, Oral Medicine and Craniofacial Pain, Tufts University, Boston, MA, USA
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Bignozzi I, Crea A, Capri D, Littarru C, Lajolo C, Tatakis DN. Root caries: a periodontal perspective. J Periodontal Res 2013; 49:143-63. [PMID: 23647556 DOI: 10.1111/jre.12094] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs. MATERIAL AND METHODS The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders. RESULTS Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking. CONCLUSION Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.
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Affiliation(s)
- I Bignozzi
- EduPERIO Periodontal Education and Research International Organization, Rome, Italy
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Gluzman R, Katz RV, Frey BJ, McGowan R. Prevention of root caries: a literature review of primary and secondary preventive agents. SPECIAL CARE IN DENTISTRY 2012; 33:133-40. [PMID: 23600985 DOI: 10.1111/j.1754-4505.2012.00318.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This literature review summarizes the effectiveness of the seven leading root caries preventive agents and provides recommendations for use of those agents in clinical practice with older adults and vulnerable elderly. METHOD Studies were eligible if they assessed the effectiveness of either fluoride, chlorhexidine, xylitol, amorphous calcium phosphate, sealants, saliva stimulators, or silver diamine fluoride to prevent/control root caries in an English language articles between 1979 and 2010. RESULTS In the 31 eligible studies, the most effective primary (1°) prevention agents had reductions in RC incidence ranging from 72% to nearly 200% as compared to a placebo while for secondary (2°) prevention, the best agents demonstrated arrest rates between 67 and 80%. CONCLUSION For 1° prevention of root caries the recommended "best choice" is a 38% Silver Diamine Fluoride solution professionally applied annually, while for the 2° prevention of root caries, the recommended "best choice" is a 22,500 ppm Sodium Fluoride varnish professionally applied every 3 months.
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Affiliation(s)
- Rima Gluzman
- Department of Epidemiology and Health Promotion, NYU College of Dentistry, NY, USA
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Epstein JB, Thariat J, Bensadoun RJ, Barasch A, Murphy BA, Kolnick L, Popplewell L, Maghami E. Oral complications of cancer and cancer therapy: from cancer treatment to survivorship. CA Cancer J Clin 2012; 62:400-22. [PMID: 22972543 DOI: 10.3322/caac.21157] [Citation(s) in RCA: 283] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Answer questions and earn CME/CNE Oral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long-term oral health and general well-being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long-term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long-term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time.
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Affiliation(s)
- Joel B Epstein
- Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA, USA.
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Schweyen R, Hey J, Fränzel W, Vordermark D, Hildebrandt G, Kuhnt T. [Radiation-related caries: etiology and possible preventive strategies. What should the radiotherapist know?]. Strahlenther Onkol 2011; 188:21-8. [PMID: 22189435 DOI: 10.1007/s00066-011-0011-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 06/30/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND After radiation treatment of head-and-neck cancer, the impairment of patient's quality of life still remains an issue. After completion of the treatment course, a substantial number of patients develop so-called radiation caries. In addition, almost 50% of all cases of infectious osteoradionecrosis (iORN) of the jaws are directly associated with radiation caries. This review addresses our current knowledge on the etiology and pathogenesis of radiation caries including possible preventive strategies. MATERIALS AND METHODS A PubMed search using the terms "radiation caries" ("radiation related caries", "radiation related damage to dentition") and "radiogenic caries" ("postradiation caries", "dental complications and radiotherapy") was performed. The analysis of its content focused on the etiology, the pathogenesis, and the available knowledge on prophylaxis as well as treatment of radiation caries. RESULTS For this review, 60 publications were selected. As main causal factors for radiogenic caries, either indirect impairment, resulting from alterations in the oral environment (e.g., radiation-induced xerostomia) or direct radiation-induced damage in teeth hard tissues are discussed. Radiation caries remains a lifelong threat and, therefore, requires permanent prevention programs. CONCLUSION To enable optimal medical care of the patients during the time course of radiotherapy as well as afterwards, close interdisciplinary cooperation between radiotherapists, oral surgeons, otorhinolaryngologists, and dentists is absolutely essential.
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Affiliation(s)
- R Schweyen
- Universitätspoliklinik für Prothetik, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland
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46
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Rodrigues JA, Lussi A, Seemann R, Neuhaus KW. Prevention of crown and root caries in adults. Periodontol 2000 2010; 55:231-49. [DOI: 10.1111/j.1600-0757.2010.00381.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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48
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Vollmer WM, Papas AS, Bader JD, Maupomé G, Gullion CM, Hollis JF, Snyder JJ, Fellows JL, Laws RL, White BA. Design of the Prevention of Adult Caries Study (PACS): a randomized clinical trial assessing the effect of a chlorhexidine dental coating for the prevention of adult caries. BMC Oral Health 2010; 10:23. [PMID: 20923557 PMCID: PMC2976725 DOI: 10.1186/1472-6831-10-23] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 10/05/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental caries is one of the primary causes of tooth loss among adults. It is estimated to affect a majority of Americans aged 55 and older, with a disproportionately higher burden in disadvantaged populations. Although a number of treatments are currently in use for caries prevention in adults, evidence for their efficacy and effectiveness is limited. METHODS/DESIGN The Prevention of Adult Caries Study (PACS) is a multicenter, placebo-controlled, double-blind, randomized clinical trial of the efficacy of a chlorhexidine (10% w/v) dental coating in preventing adult caries. Participants (n = 983) were recruited from four different dental delivery systems serving four diverse communities, including one American Indian population, and were randomized to receive either chlorhexidine or a placebo treatment. The primary outcome is the net caries increment (including non-cavitated lesions) from baseline to 13 months of follow-up. A cost-effectiveness analysis also will be considered. DISCUSSION This new dental treatment, if efficacious and approved for use by the Food and Drug Administration (FDA), would become a new in-office, anti-microbial agent for the prevention of adult caries in the United States. TRIAL REGISTRATION NUMBER NCT00357877.
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Affiliation(s)
- William M Vollmer
- Center for Health Research, 3800 N, Interstate Blvd, Portland, Oregon 97227, USA.
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Cochrane N, Cai F, Huq N, Burrow M, Reynolds E. New Approaches to Enhanced Remineralization of Tooth Enamel. J Dent Res 2010; 89:1187-97. [DOI: 10.1177/0022034510376046] [Citation(s) in RCA: 332] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dental caries is a highly prevalent diet-related disease and is a major public health problem. A goal of modern dentistry is to manage non-cavitated caries lesions non-invasively through remineralization in an attempt to prevent disease progression and improve aesthetics, strength, and function. Remineralization is defined as the process whereby calcium and phosphate ions are supplied from a source external to the tooth to promote ion deposition into crystal voids in demineralized enamel, to produce net mineral gain. Recently, a range of novel calcium-phosphate-based remineralization delivery systems has been developed for clinical application. These delivery systems include crystalline, unstabilized amorphous, or stabilized amorphous formulations of calcium phosphate. These systems are reviewed, and the technology with the most scientific evidence to support its clinical use is the remineralizing system utilizing casein phosphopeptides to stabilize and deliver bioavailable calcium, phosphate, and fluoride ions. The recent clinical evidence for this technology is presented and the mechanism of action discussed. Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization show promise for the non-invasive management of dental caries.
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Affiliation(s)
- N.J. Cochrane
- Cooperative Research Centre for Oral Health Science, Melbourne Dental School, Bi021 Institute, The University of Melbourne, 720 Swanston Street, Victoria 3000, Australia
| | - F. Cai
- Cooperative Research Centre for Oral Health Science, Melbourne Dental School, Bi021 Institute, The University of Melbourne, 720 Swanston Street, Victoria 3000, Australia
| | - N.L. Huq
- Cooperative Research Centre for Oral Health Science, Melbourne Dental School, Bi021 Institute, The University of Melbourne, 720 Swanston Street, Victoria 3000, Australia
| | - M.F. Burrow
- Cooperative Research Centre for Oral Health Science, Melbourne Dental School, Bi021 Institute, The University of Melbourne, 720 Swanston Street, Victoria 3000, Australia
| | - E.C. Reynolds
- Cooperative Research Centre for Oral Health Science, Melbourne Dental School, Bi021 Institute, The University of Melbourne, 720 Swanston Street, Victoria 3000, Australia
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Hong CHL, Napeñas JJ, Hodgson BD, Stokman MA, Mathers-Stauffer V, Elting LS, Spijkervet FKL, Brennan MT. A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer 2010; 18:1007-21. [PMID: 20449756 PMCID: PMC2914291 DOI: 10.1007/s00520-010-0873-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 03/29/2010] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This purpose of this systematic review was to evaluate the literature and update our current understanding of the impact of present cancer therapies on the dental apparatus (teeth and periodontium) since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies. REVIEW METHOD A systematic literature search was conducted with assistance from a research librarian in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 1990 and 31 December 2008. Each study was independently assessed by two reviewers. Taking into account predetermined quality measures, a weighted prevalence was calculated for the prevalence of dental caries, severe gingival disease, and dental infection. Data on DMFT/dmft, DMFS/dmfs, plaque, and gingival indexes were also gathered. The level of evidence, recommendation, and guideline (if possible) were given for published preventive and management strategies. RESULTS Sixty-four published papers between 1990 and 2008 were reviewed. The weighted overall prevalence of dental caries was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (SD, 7.98; n = 457). The overall plaque index for patients who were post-antineoplastic therapy was 1.38 (SD, 0.25; n = 189). The GI for patients who were post-chemotherapy was 1.02 (SD, 0.15; n = 162). The weighted prevalence of dental infections/abscess during chemotherapy was reported in three studies and was 5.8%. CONCLUSIONS Patients who were post-radiotherapy had the highest DMFT. The use of fluoride products and chlorhexidine rinses are beneficial in patients who are post-radiotherapy. There continues to be lack of clinical studies on the extent and severity of dental disease that are associated with infectious complications during cancer therapy.
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Affiliation(s)
- Catherine H. L. Hong
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
| | - Joel J. Napeñas
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
| | - Brian D. Hodgson
- Program in Pediatric Dentistry, Department of Developmental Sciences, Marquette University School of Dentistry, 1801 W. Wisconsin Ave, Milwaukee, WI 53233 USA
| | - Monique A. Stokman
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | | | - Linda S. Elting
- The University of Texas M.D. Anderson Cancer Centre, P.O. Box 301402, Houston, TX 77230-1402 USA
| | - Fred K. L. Spijkervet
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RG Groningen, The Netherlands
| | - Michael T. Brennan
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
| | - Dental Disease Section, Oral Care Study Group, Multi-national Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO)
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
- Program in Pediatric Dentistry, Department of Developmental Sciences, Marquette University School of Dentistry, 1801 W. Wisconsin Ave, Milwaukee, WI 53233 USA
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Penrose Cancer Center, 2222 North Nevada Avenue, Colorado Springs, CO 80907 USA
- The University of Texas M.D. Anderson Cancer Centre, P.O. Box 301402, Houston, TX 77230-1402 USA
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RG Groningen, The Netherlands
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