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Bastos Silveira B, Di Carvalho Melo L, Amorim Dos Santos J, Ferreira EB, Reis PED, De Luca Canto G, Acevedo AC, Massignan C, Guerra ENS. Oral manifestations in pediatric patients with leukemia: A systematic review and meta-analysis. J Am Dent Assoc 2024:S0002-8177(24)00395-7. [PMID: 39254613 DOI: 10.1016/j.adaj.2024.07.014] [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: 01/23/2024] [Revised: 07/18/2024] [Accepted: 07/29/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Leukemia is the most common malignancy in pediatric patients, and it has extramedullary involvement. Oral manifestations have been reported in the literature, but to the authors' knowledge, no systematic review has presented the general prevalence of these manifestations. This review aimed to determine the prevalence of oral manifestations in pediatric patients with leukemia. TYPES OF STUDIES REVIEWED The authors conducted a search of PubMed-MEDLINE, Embase, Latin American and Caribbean Health Sciences Literature, Web of Science, and Scopus. Additional searches were carried out in the gray literature and via hand searching of reference lists of included studies. The inclusion criteria were observational studies that investigated the prevalence and occurrence of oral lesions in pediatric patients with leukemia. Two independent reviewers collected data from the selected articles in a prepiloted Excel (Microsoft) spreadsheet. RESULTS From 67 included studies, 79 oral manifestations were reported. The most frequent alteration in children with acute lymphoblastic leukemia during the treatment were caries (81%), with moderate certainty of evidence. The prevalence of gingivitis was 73%, oral mucositis was 50%, and lymphadenopathy was 45%, with very low certainty of evidence. After the therapy, the prevalence of dental anomalies was 61%, and the most common were enamel hypoplasia (40%), dental agenesis (22%), and microdontia (22%), presenting very low certainty of evidence. The high heterogeneity among studies contributed significantly to reduce the certainty of the evidence. PRACTICAL IMPLICATIONS The findings of this study show that pediatric patients with leukemia have oral manifestations predominantly during and after treatment. Health care professionals must be aware of oral manifestations and refer the patients to dentists during the oncological treatment. Thus, the dentist must support pediatric patients with leukemia to help ensure a better quality of life.
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Gan RH, Lan LQ, Sun DN, Tang F, Niu G, Zheng DL, Wang B, Lu YG. Effect of different approaches of direct radiation on the surface structure and caries susceptibility of enamel. Sci Rep 2024; 14:20183. [PMID: 39215189 PMCID: PMC11364863 DOI: 10.1038/s41598-024-71277-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
It is not clear whether different radiation methods have different effects on enamel. The purpose of this study was to compare the effects of single and fractionated radiation on enamel and caries susceptibility and to provide an experimental basis for further study of radiation‑related caries. Thirty-six caries-free human third molars were collected and randomly divided into three groups (n = 12). Group1 (control group) was not exposed to radiation. Group 2 received single radiation with a cumulative dose of 70 Gy. Group 3 underwent fractionated radiation, receiving 2 Gy/day for 5 days followed by a 2-day rest period, for a total of 7 weeks with a cumulative dose of 70 Gy. Changes in microhardness, roughness, surface morphology, bacterial adhesion and ability of acid resistance of each group were tested. Scanning electron microscope revealed that the enamel surface in both radiation groups exhibited unevenness and cracks. Compared with the control group, microhardness and acid resistance of enamel decreased, while roughness and bacterial adhesion increased in both the single radiation and fractionated radiation groups. Compared with the single radiation group, the enamel surface microhardness and acid resistance decreased in the fractionated radiation group, while roughness and bacterial adhesion increased. Both single radiation and fractionated radiation resulting in changes in the physical and biological properties of enamel, with these changes being more pronounced in the fractionated radiation group. Therefore, fractionated radiation is recommended as a more suitable method for constructing a radiation‑related caries model in vitro.
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Affiliation(s)
- Rui-Huan Gan
- Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
- Department of Preventive Dentistry, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Li-Qing Lan
- Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
- Department of Preventive Dentistry, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Dan-Ni Sun
- Department of Stomatology, San Ming First Hospital, San Ming, China
| | - Fan Tang
- Department of Radiotherapy, San Ming First Hospital, San Ming, China
| | - Gang Niu
- Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Da-Li Zheng
- Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Bin Wang
- Department of Stomatology, San Ming First Hospital, San Ming, China.
| | - You-Guang Lu
- Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China.
- Department of Preventive Dentistry, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China.
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Saikaew P, Katekovit K, Buranarachada A, Saimala N, Prayongrat A, Fuangtharnthip P. Effects of NaF versus SDF treatment on microhardness of artificial radiation caries at cervical and root areas. Dent Mater J 2024; 43:591-596. [PMID: 38925978 DOI: 10.4012/dmj.2024-032] [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] [Indexed: 06/28/2024]
Abstract
This study aimed to compare the effect of silver diamine fluoride (SDF) and fluoride varnish (NaF) on the Vickers microhardness (VHN) of enamel and dentin after radiotherapy and pH-cycling. Human premolars were cut longitudinally, embedded and serially polished. The VHN of enamel/dentin and irradiated enamel/dentin were evaluated. The irradiated specimens were treated with either NaF or SDF, subjected to pH-cycling then VHN test for 4 days. Consequently, they were subjected to energy-dispersive X-ray (EDX) analysis. Radiation adversely affect enamel VHN (p<0.05), whereas dentin VHN was not affected (p>0.05). After pH-cycling, a significant decrease in dentin VHN was observed on day 2 for all groups, whereas enamel VHN was significantly decreased in the control group on day 4. SDF-treated enamel demonstrated higher VHN than that of NaF on day 3. Caries prevention effect of SDF and NaF were observed on enamel, where SDF was proved to be superior to NaF.
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Affiliation(s)
- Pipop Saikaew
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University
| | | | | | | | - Anussara Prayongrat
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital
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Sankar V, Xu Y. Oral Complications from Oropharyngeal Cancer Therapy. Cancers (Basel) 2023; 15:4548. [PMID: 37760517 PMCID: PMC10526346 DOI: 10.3390/cancers15184548] [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: 08/15/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Post-oropharyngeal cancer treatment complications include a multitude of oral side effects that impact overall survival and quality of life. These include acute and chronic conditions affecting the oral cavity and head and neck, such as mucositis, infection, xerostomia, dysgeusia, radiation caries, osteonecrosis, and trismus. This review will summarize the most common oral complications from oropharyngeal cancer therapy. The authors would like to point out that the literature cited frequently combines oropharyngeal and head and neck cancer results. If recommendations are made strictly related to oropharyngeal cancers, this will be highlighted.
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Affiliation(s)
- Vidya Sankar
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA 02111, USA;
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Klarić E, Tarle A, Vukelja J, Soče M, Grego T, Janković B. Remineralization effects of Er,Cr:YSGG and/or bioactive glass on human enamel after radiotherapy-an in vitro study. Lasers Med Sci 2023; 38:65. [PMID: 36746823 DOI: 10.1007/s10103-023-03726-0] [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: 11/17/2021] [Accepted: 01/17/2023] [Indexed: 02/08/2023]
Abstract
The aim was to evaluate the effects of Er,Cr:YSGG and/or bioactive glass 45S5 (BG) on the chemical and physical properties of enamel after radiotherapy. Third molar crowns were cut in half (buccal-lingually), and the mid part of the labial/oral surface was subjected to different protocols. All samples were treated with standard 70 Gy. After radiotherapy, enamel was treated with either Er,Cr:YSGG (2780 nm; pulse 60 μs) and BG or only BG, and control samples were kept in deionized water. Vickers microhardness, scanning electron microscopy (SEM), and characteristic X-ray spectroscopy (EDS) were performed before, after radiotherapy, and after treatment. Analysis of variance (ANOVA) was used. A significant drop in enamel microhardness was observed after radiotherapy (p < 0.001). After Er,Cr:YSGG and BG or BG alone, there was a significant increase in microhardness (p < 0.001), which was on average significantly higher compared to the initial measurements for Er,Cr:YSGG with BG (p < 0.001), but not observed in BG alone (p = 0.331). After radiotherapy, SEM showed increased surface roughness with eroded prisms. Er,Cr:YSGG and BG or BG alone both showed disorderly packed glass particles on the enamel surface. Radiotherapy noticeably reduced the concentrations of calcium and phosphorus. Er,Cr:YSGG and BG treatment increased the concentrations of calcium, sodium, phosphorus, and silicate. BG treatment alone increased the concetration of calcium and phosphorus. Directly induced radiotherapy led to potential damage of enamel, but afterwards treatment with Er,Cr:YSGG laser and BG resulted in a higher increase of enamel microhardness compared to BG alone, reflecting in a possible better remineralization effect.
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Affiliation(s)
- Eva Klarić
- Department of Endodontics and Restorative Dental Medicine, University of Zagreb School of Dental Medicine, Zagreb, Croatia.
| | - Andro Tarle
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - Josipa Vukelja
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Majana Soče
- Department of Oncology, Radiotherapy Unit, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Timor Grego
- Department of Oncology, Radiotherapy Unit, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Bernard Janković
- Department of Endodontics and Restorative Dental Medicine, University of Zagreb School of Dental Medicine, Zagreb, Croatia
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Pedroso CM, Normando AGC, Pérez-de-Oliveira ME, Palmier NR, Guerra ENS, Epstein JB, Lopes MA, Ribeiro ACP, Brandão TB, Bensadoun RJ, Marta GN, de Goes MF, Santos-Silva AR. Dosimetric parameters and radiotherapy simulation methods used in preclinical studies of radiation damage to the dentition: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:614-625. [PMID: 36725442 DOI: 10.1016/j.oooo.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/19/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This systematic review investigated the dosimetric parameters used in preclinical studies. STUDY DESIGN Searches were performed in 3 databases (PubMed, Scopus, and Embase) and gray literature to identify studies for review. In vitro and ex vivo studies that examined the effect of radiation on human permanent teeth were included. The modified Consolidated Standards Of Reporting Trials checklist of items for reporting preclinical in vitro studies was used to assess the risk of bias. RESULTS In total, 32 studies met the inclusion criteria. The average radiation dose of in vitro studies was 53 (±22) Gy and in ex vivo studies was 69 (±1) Gy. Twenty-two studies used 5 different fractionation schemes. Twenty-two of the included studies did not report the radiotherapy modality of those reporting. Twenty studies used linear accelerators, and 7 used Cobalt-60 with the source-surface-distance of radiation ranging from 1.5 to 100 cm. Distilled water was the storage solution for the dental structure used most commonly. Biases were observed, including small sample sizes, lack of randomization, and blinding processes. CONCLUSION The dosimetric parameters used in the preclinical studies, including radiation dose, radiotherapy modality, fractionation regime, and the storage solutions used did not support the hypothesis of direct effects of radiation on the dental structure.
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Affiliation(s)
- Caique Mariano Pedroso
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Ana Gabriela Costa Normando
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | - Natália Rangel Palmier
- Serviço de Odontologia Oncológica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eliete Neves Silva Guerra
- Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasília (UnB), Brasília, Brazil
| | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Ana Carolina Prado Ribeiro
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Serviço de Odontologia Oncológica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thaís Bianca Brandão
- Serviço de Odontologia Oncológica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Mario Fernando de Goes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
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Wali R, Sacco R, Singh G, Patel V. The clinical effect of radiotherapy on pulpal microvasculature: a systematic review. Br Dent J 2022:10.1038/s41415-022-5301-8. [PMID: 36473977 DOI: 10.1038/s41415-022-5301-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/29/2022] [Indexed: 12/12/2022]
Abstract
Introduction/objectives Radiotherapy (RT) has a detrimental effect on the histomorphology of oral tissues. Patients undergoing RT are at risk of developing macrovascular and microvascular changes, which can lead to significant clinical consequences. Despite advances in RT delivery systems, radiation injury remains a modern-day clinical problem. The aim of this systematic review is to investigate the available evidence regarding the impact of RT to the dental pulp and the clinical manifestations of these effects.Data and sources A multi-database search (PubMed, Medline, Embase and CINAHL) was performed to identify related papers published from inception until November 2021. An additional manual search was performed to identify further articles. The data extracted from relevant papers were analysed according to the outcomes selected in this review.Study selection The search generated seven articles eligible for analysis with a total of 2,709 teeth included. RT dose exposure ranged from 30-71.2 Gray with a common finding that RT decreases the number of teeth responding to pulp sensibility testing.Conclusions Knowledge related to the impact of RT on dental pulp is limited and based on weak evidence and a low-level quality of studies. Future studies should incorporate exact RT doses to the teeth and use replicable pulpal testing methods. Understanding the pulpal status post-RT remains an important consideration as dental extractions should be avoided in this cohort due to the risk of osteoradionecrosis.
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Affiliation(s)
- Rana Wali
- Oral Surgery Registrar, Oral Surgery Department, Guy´s and St Thomas´ Hospital, London, UK
| | - Roberto Sacco
- Clinical Lecturer, Division of Dentistry, School of Medical Sciences, Oral Surgery Department, University of Manchester, Manchester, UK; 3Clinical Teacher, Oral Surgery Department, King´s College Hospital, London, UK
| | - Gurpreet Singh
- Managed Clinical Network Chair, Restorative Dentistry, NHS England and NHS Improvement East of England, UK
| | - Vinod Patel
- Oral Surgery Consultant, Oral Surgery Department, Guy´s and St Thomas´ Hospital, London, UK.
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Pedroso CM, Migliorati CA, Epstein JB, Ribeiro ACP, Brandão TB, Lopes MA, de Goes MF, Santos-Silva AR. Over 300 Radiation Caries Papers: Reflections From the Rearview Mirror. FRONTIERS IN ORAL HEALTH 2022; 3:961594. [PMID: 35911379 PMCID: PMC9330023 DOI: 10.3389/froh.2022.961594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Radiation caries (RC) is an aggressive oral toxicity in head and neck cancer survivors, which develops 6 to 12 months after head and neck radiotherapy. It initially affects the tooth cervical/incisal surfaces, and if not promptly diagnosed/managed, progresses to dental crown amputation and risk of osteoradionecrosis. It results from a multidimensional cluster of treatment-induced oral symptoms, including hyposalivation, dietary changes, and oral hygiene impairment. Although recognized as a frequent complication of radiotherapy and extensively assessed by a myriad of retrospective, in vitro, and in situ studies, RC patients are still orphans of clinically validated methods for risk prediction, prevention, and treatment of early lesions. This review provides a historical overview of science-based concepts regarding RC pathogenesis and treatment, emphasizing the growing demand for interventional clinical studies (randomized trials).
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Affiliation(s)
- Caique Mariano Pedroso
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Joel B. Epstein
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, United States
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | | | - Thaís Bianca Brandão
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, United States
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mário Fernando de Goes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
- *Correspondence: Alan Roger Santos-Silva
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Conti GB, de Lima Oliveira RF, Amorim AA, de Oliveira HF, Pires-de-Souza FDCP, de Queiroz AM. Color stability and microhardness alteration of irradiated dental enamel treated with a high fluoride concentration toothpaste. Clin Oral Investig 2022; 26:5885-5892. [PMID: 35590118 DOI: 10.1007/s00784-022-04546-2] [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: 01/17/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Radiotherapy (RT) is a kind of head and neck cancer (HNC) treatment, which is associated to the habit of smoking and can develop collateral effects in the oral cavity, such as the increase of caries prevalence. This study evaluated the color alteration, the microhardness, and the remineralizing potential of high fluoride concentration toothpastes on irradiated teeth. MATERIALS AND METHODS Forty bovine teeth were used (6 × 6 × 2 mm) and after color (EasyShade, VITA) and microhardness initial readings were separated into two groups: exposed to cigarette smoke and non-exposed. All samples were submitted to RT (30 Gy) and to cariogenic challenge. New color and microhardness readings were done. After RT (60 Gy), the samples were submitted to simulated toothbrushing (73,000 cycles = 5 years of brushing) with two different toothpastes: conventional (1450 ppm) and high fluoride concentration (5000 ppm). Final color and microhardness readings were done after brushing. Data were analyzed with 2-way ANOVA with repeated measures and Tukey's test (p < .05). RESULTS There was no color difference after RT, nor after brushing (p > .05). However, after brushing, microhardness values increased for the samples treated with high fluoride concentration toothpaste (p < .05). CONCLUSION Radiotherapy did not influence the teeth color, and the high fluoride concentration toothpaste presented remineralizing potential; therefore, it could be used on the caries prevention related to HNC radiation. CLINICAL RELEVANCE Considering its remineralizing potential, toothpastes with high fluoride concentration could be a proper alternative for caries prevention in patients undergoing radiotherapy.
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Affiliation(s)
- Giulia Battistini Conti
- Department of Pediatric Dentistry, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Café, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
| | - Rebeca Franco de Lima Oliveira
- Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
| | - Ayodele Alves Amorim
- Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
| | | | - Fernanda de Carvalho Panzeri Pires-de-Souza
- Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil.
- Faculty of Dentistry of Ribeirao Preto, University of Sao Paulo, Av. do Cafe, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil.
| | - Alexandra Mussolino de Queiroz
- Department of Pediatric Dentistry, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, Av. do Café, s/nº, Monte Alegre, 14040-904, Ribeirão Preto, Brazil
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Atef R, Zaky AA, Waly N, El Rouby D, Ezzeldin N. Effect of Diode Laser and Remineralizing Agents on Microstructure and Surface Microhardness of Therapeutic Gamma-Irradiated Primary Teeth Enamel. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Radiation caries is a serious complication to head and neck cancer (HNC) radiotherapy, for which the primary teeth are more susceptible to be affected. Preventive protocols are recommended to enhance dental structure resistance against the direct effects of radiotherapy.
AIM: The aim of the study is to evaluate the effect of diode laser and two types of remineralizing agents on the microhardness of the primary teeth enamel and examine microstructural alterations.
METHODS: Twenty primary molars were sectioned into two halves in a mesiodistal direction, to obtain 40 specimens, which were then randomly allocated into five groups. Group 1 (Control Negative) n = 5 was not subjected to any treatment or radiation. Group 2 (Control positive) n = 5 was gamma irradiated with a dose of 60 Gray. For Groups 3, 4, and 5, specimens were divided into two subgroups: A and B (n = 5/subgroup). Subgroups A were gamma irradiated, then exposed to different surface treatments: 3A:10% nano-hydroxyapatite (nHA) paste, 4A: 5% sodium fluoride varnish (FV), and 5A: diode laser 980 nm. Subgroups B were exposed to surface treatments (3B: 10% nHA, 4 B: 5% FV, and 5B: diode laser 980 nm), then gamma irradiated. Surface micromorphology and microhardness were examined using environmental scanning electron microscope (ESEM), and Vickers microhardness tester, respectively.
RESULTS: Group 2 (G) specimens possessed the lowest mean microhardness, while nHA-G (3B), G-Fl (4A), and L-G (5B) had significantly higher values. ESEM analysis showed an alteration in Group G and the obliteration of enamel micropores with remineralizing agents. The melting and fusion of enamel in laser subgroups were also observed.
CONCLUSIONS: The findings indicated that using FV, nHA, or diode laser increased microhardness and maintained the integrity of the enamel microstructure. Therefore, applying preventive strategies should be considered in HNC radiotherapy.
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Douchy L, Gauthier R, Abouelleil-Sayed H, Colon P, Grosgogeat B, Bosco J. The effect of therapeutic radiation on dental enamel and dentin: A systematic review. Dent Mater 2022; 38:e181-e201. [DOI: 10.1016/j.dental.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/03/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
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Klarić Sever E, Tarle A, Vukelja J, Soče M, Grego T. Direct Induced Effects of Standard and Modified Radiotherapy Protocol on Surface Structure of Hard Dental Tissue. Acta Stomatol Croat 2022; 55:334-345. [PMID: 35001929 PMCID: PMC8734449 DOI: 10.15644/asc55/4/1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/20/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Radiotherapy is used to treat neo plasmatic lesions and the common side effects of this process are pain, swelling and sensitivity of mucous membranes in domain of radiation, reduced salivation, caries, and periodontal disease and, in total, low life quality. The purpose of this research was to estimate the outcome of direct irradiation on physical and surface characteristics of hard dental tissues. Materials and methods Twenty, caries free third molars were involved in the research. Prior to different submission protocols, tooth halves were randomly assigned to subject and control groups by using a draw method. The first group (n=20) was submitted to conventional irradiation protocol (2 Gy for 35 days), second group (n=20) was submitted to one powerful, exploratory dose of 70 Gy. Each sample served as its own control. Radiation was performed with a linear accelerator radiotherapy unit. The surface microhardness and roughness were measured at the beginning (initially), and upon completion of irradiation procedure. The average change in microhardness and roughness after different treatments was compared by t-test for independent samples. Normality was tested by the Shapiro-Wilk test. Results Significant differences were found after the standard radiation protocol and the exploratory dose of 70 Gy, with decreased mean microhardness and increased mean roughness (p<0.001) of both hard dental tissues. Enamel and dentin surface microhardness and roughness did not vary notably with regards to different irradiation protocols. Conclusion Head and neck conventional irradiation protocol leads to possible breakdown of enamel and dentin with reduced microhardness and increased surface roughness regardless of used irradiation protocol.
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Affiliation(s)
- Eva Klarić Sever
- Department of Endodontics and Restorative Dental Medicine, School of Dental Medicine Zagreb
| | | | - Josipa Vukelja
- PhD student, School of Dental Medicine, University of Zagreb, Croatia
| | - Majana Soče
- Department of Oncology, Radiotherapy Unit, University Hospital Centre Zagreb, Zagreb
| | - Timor Grego
- Department of Oncology, Radiotherapy Unit, University Hospital Centre Zagreb, Zagreb
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Klarić Sever E, Tarle A, Soče M, Grego T. Direct Radiotherapy-Induced Effects on Dental Hard Tissue in Combination With Bleaching Procedure. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.714400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Introduction: The aim of this study was to evaluate the effects of radiation and tooth bleaching on the physical and morphological properties of enamel and dentin on permanent teeth.Materials and Methods: Eighty fresh, non-carious third molars were used in this study. Before cutting the crown in half, the teeth samples were randomly allocated to treatment and control groups by using a lottery method. The first group (n = 20) underwent standard radiation protocol (2 Gy/fraction/day, 5 days/week) with bleaching treatment afterward using 16% carbamide peroxide gel, the second group (n = 20) underwent standard radiation protocol with afterward bleaching treatment using 38% hydrogen peroxide, the third group (n = 20) underwent a short, one strong, experimental dose of 70 Gy with afterward bleaching treatment using 16% carbamide peroxide gel, and the fourth group (n = 20) underwent one strong, experimental dose of 70 Gy with afterward bleaching treatment using 38% hydrogen peroxide gel. Groups 5–8 (n = 20) served as control as they underwent only bleaching treatment. Vickers microhardness and surface roughness were performed before (initial) and after irradiation and before bleaching or after only bleaching. The effects of irradiation and bleaching on microhardness (or roughness) of enamel and dentin were analyzed in the repeated-measures ANOVA model.Results: Enamel microhardness after experimental single 70-Gy irradiation or after standard radiation protocol and bleaching with 16 or 38% gel was not statistically significant from microhardness in the control group (p > 0.05). There was a statistically significantly greater reduction in the average microhardness of enamel and dentin during bleaching with 38% gel compared to 16% for both radiation protocols (p < 0.001). After experimental 70-Gy irradiation and bleaching, a 16% statistically significant increase in surface roughness was found for enamel (p = 0.006) and dentin (p = 0.018), while this was not recorded for 38% gel. There was a statistically significantly greater increase in the average roughness of enamel and dentin during bleaching with 38% gel compared to 16% (p < 0.001) for both radiation protocols.Conclusions: Directly induced radiation leads to potential damage of hard dental tissues, which can be further damaged by additional bleaching. If teeth whitening is necessary after irradiation, it is suggested to use lower concentrations of whitening gels.
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