Genotoxic effects of X-rays on keratinized mucosa cells during panoramic dental radiography

Is micronucleus assay a useful marker in gingiva, tongue, and palate for evaluating cytogenetic damage induced by chemical, physical, and biological agents in vivo? A systematic review with meta-analysis

The present systematic review (SR) aims to evaluate manuscripts in order to help further elucidate the following question: is the micronucleus assay (MA) also a useful marker in gingiva, tongue, and palate for evaluating cytogenetic damage in vivo? A search was performed through the electronic databases PubMed/Medline, Scopus, and Web of Science, all studies published up to December 2023. The comparisons were defined as standardized mean difference (SMD), and 95% confidence intervals (CIs) were established. Full manuscripts from 34 studies were carefully selected and reviewed in this setting. Our results demonstrate that the MA may be a useful biomarker of gingival tissue damage in vivo, and this tissue could be a useful alternative to the buccal mucosa. The meta-analysis analyzing the different sites regardless of the deleterious factor studied, the buccal mucosa (SMD = 0.69, 95% CI, - 0.49 to 1.88, p = 0.25) and gingiva (SMD = 0.31, 95% CI, - 0.11 to 0.72, p = 0.15), showed similar results and different outcome for the tongue (SMD = 1.19, 95% CI, 0.47 to 1.91, p = 0.001). In summary, our conclusion suggests that the MA can be a useful marker for detecting DNA damage in gingiva in vivo and that this tissue could be effective site for smearing.

Micronuclei as an indicator of genotoxic change in epithelial cells of buccal mucosa after panoramic radiographs

BACKGROUND

The radiation released at the time of dental panoramic radiographs causes genotoxic and cytotoxic effects on epithelial cells.

OBJECTIVE

This research aimed to evaluate the changes in the frequencies of micronucleated cells in patients' buccal epithelial cells following dental panoramic radiography.

METHODS

74 patients were recruited for the study who were advised for panoramic radiographs. Using a wooden spatula, the buccal epithelial cells were scraped from both cheeks before to panoramic radiation exposure and ten days after the panoramic radiation exposure. Giemsa stain was used to stain the cells, and 500 cells were scored on a slide to determine the frequency of micronuclei. To determine the difference between the frequency of micronuclei before and after radiation exposure, a paired t-test was used in the statistical analysis.

RESULTS

The proportion of micronuclei cells was 0.11% before radiation exposure and 0.57% following radiation exposure after 10 days. A statistically significant increase in the frequencies of micronuclei was noted after radiation exposure values.

CONCLUSION

This study revealed the genotoxicity of epithelial cells with dental panoramic radiation exposure. It is advised to reduce the use of such radiographs and to use only when there is no other diagnostic tool that is helpful or when absolutely essential.

Panoramic dental X-ray exposure leads to oxidative stress, inflammation and apoptosis-mediated developmental defects in zebrafish embryos

Panoramic x-ray units are widely used in dental radiodiagnostics. Patients are exposed to relatively low radiation doses with panoramic imaging, but considering lifetime frequency of exposure, even a small risk can have serious health consequences. Our aim was to assess the effects of panoramic x-rays at two different exposure times on developing zebrafish embryos, focusing on oxidative stress, inflammation, apoptotic pathways, and development. Zebrafish embryos were divided into three groups: control, standard panoramic (SPE, 5.5 s exposure time) and pedodontic panoramic x-ray group (PPE, 4.8 s exposure time). Optically stimulated luminescence dosimeters were used to measure absorbed doses. Mean radiation doses for SPE and PPE were 7.83 mSv and 5.83 mSv respectively. At the end of 96 h post-fertilization, lipid peroxidation (LPO), nitric oxide (NO), reduced glutathione (GSH), glutathione S-transferase and superoxide dismutase were measured in the embryos. Expressions of genes related with inflammation (tnfα, il6, ill15, il21), immunoregulation (ifng) and apoptosis (p53, bax, casp2, casp3, casp8) were determined by RT-PCR. Even at reduced doses at high-speed mode, developmental toxicity was observed in both groups as evidenced by decreased pigmentation, yolk sac oedema, and spinal curvature. While deterioration of oxidant-antioxidant balance, suppression of immune response, induction of inflammation and apoptosis were observed through increased LPO, NO, decreased GSH, ifng, and increased expressions of genes related with inflammation and apoptosis, these effects were more pronounced in the SPE group. These results demonstrate the influence of exposure time and indicate the need for further consideration of optimal panoramic modes from a radiation-induced damage perspective.

Comparative evaluation of mutagenic effects of two cone-beam computed tomography in oral mucosa cells

BACKGROUND

This pilot study aimed to evaluate the mutagenic effects in cells of the oral mucosa after exposure to two different cone beam computed tomography (CBCT).

METHODS

Eighteen adults were submitted to the different CBCT (Carestream CS8100 3D and I-CAT). The cells were collected immediately before the CBCT exposure and 10 days later, when the material was placed on a slide and stained using the Feulgen/Fast Green technique. Microscopic analysis counted micronuclei and other nuclear alterations, which are indicative of cytotoxicity such as pyknosis, karyolysis, karyorrhexis, and binucletion. 2000 cells were analyzed. The statistical analysis was performed with the Wilcoxon Signed-Rank test to compare the frequency of cellular alterations, and the Mann-Whitney U test to compare different CBCTs, both with a significance level of 5%.

RESULTS

There was no statistically significant difference in the micronucleated cell count before and after the exposition to the ionizing radiation from I-CAT (p = .298) and CS8100 3D (p = .203) A significate increase of pyknosis (p < .001), karyolysis (p < .001), karyorrhexis (p < .001), and binucletion (p < .001) were noted on I-CAT CBCT. There was no statistically significant difference in cellular alterations in CS8100 3D CBCT.

CONCLUSION

Despite the increase in micronuclei after exposure, this study indicates that there is no evidence of genotoxicity. On the other hand, the I-CAT CBCT produced cytotoxic effects.

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

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

Biomonitoring of Genotoxic Effect in Children Exposed to Dental Radiographs during Pulpectomy Procedure—BMCyt Assay

Background

Radiography is one of the most valuable diagnostic tools used in comprehensive dental care. Radiation from dental radiographs was thought to cause cytogenetic changes and its plausible effects can remain for some hours, months, or generations especially in children.

Aims and objectives

To evaluate and compare the possible genotoxic effect of routinely used intraoral periapical radiographic exposure and radiovisiographic exposure in exfoliated epithelial cells as measured by the formation of micronuclei during single visit pulpectomy procedure using Buccal Micronucleus Cytome (BMCyt) assay in children.

Materials and methods

Study comprised 60 healthy children who has undergone either intraoral periapical radiography (IOPAR; group 1, n = 30) or radiovisiography (RVG; group 2, n = 30) during various steps of single visit pulpectomy procedure. Cytological smears were taken from the buccal mucosa immediately before the X-ray exposure and 10 ± 2 days after exposure. The cells were stained with Feulgen and evaluated for micronuclei by scoring 1,000 cells per sample.

Results

The genotoxic effect of radiation exposure from intraoral periapical radiography higher than that of RVG showing significant increase in micronucleus (MN) formation.

Conclusion

The X-ray radiation emitted during IOPAR or RVG does induce genotoxic changes in the form of increased frequency of micronuclei. So, great care and standard protocol should be followed to advice radiographs if necessary and reduce the cumulated biological effects of radiation exposure.

Keynote

Taking into account the strong evidence of a relationship between DNA damage and carcinogenesis and the extensive application of intraoral radiographs in pediatric dentistry, it would be useful to know to what extent these dental X-rays cause genotoxic effects resulting in DNA damage on oral mucosa.

How to cite this article

Julu Y, Nagarathna C. Biomonitoring of Genotoxic Effect in Children Exposed to Dental Radiographs during Pulpectomy Procedure—BMCyt Assay. Int J Clin Pediatr Dent 2022;15(S-1):S63-S70.

Can exposure to panoramic radiographs induce genotoxic effects on the oral epithelium? A systematic review with meta-analysis

OBJECTIVE

To evaluate, through a systematic review (SR) with meta-analysis, the occurrence of genotoxic effects in the oral epithelium after the exposure of patients to panoramic radiographs.

METHODS

An SR was performed with the PICOS (Population, Intervention, Comparison, Outcome, and Study design) strategy, aiming to answer the following question: "Can panoramic radiographs induce genotoxic effects on the oral epithelium?" The study was registered in the PROSPERO (International prospective register of systematic reviews) platform. A systematic search was performed in the following electronic databases: PubMed (including MedLine), Scopus, Embase, LILACS, Medline EbscoHost, and Google Scholar. Treatment effects were defined as standardized mean difference (SMD), and 95% confidence intervals (CI) were established. The Joanna Briggs Institute questionnaire for observational studies was applied to assess the risk of bias. The GRADE tool was used to assess the quality of evidence of the SR.

RESULTS

A total of 251 potentially relevant studies were selected through the search strategy. After screening titles and abstracts, 11 full-text manuscripts were assessed for eligibility and nine observational studies were included in the meta-analysis. The present study showed an increase in micronuclei after the exposure (SMD = 0.21, 95% CI, 0.03 to 0.28, p = 0.02), with a Tau²index = 0.00, Chi² = 2.35, and p-value = 0.97. Therefore, the articles selected were considered homogeneous and the I² of 0% indicated low heterogeneity.

CONCLUSION

According to the studies analysed, although the quality of evidence was considered low, panoramic radiographs can cause genotoxic damage in the oral epithelium but with a small effect size.

Radiobiological risks following dentomaxillofacial imaging: should we be concerned?

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Biomonitoring of children and adolescents using orthodontic appliances made of acrylic resins through micronucleus testing of exfoliated buccal and palatal mucosa cells

INTRODUCTION

The present study aimed to investigate the occurrence of micronuclei and the degenerative nuclear alterations indicative of apoptosis and necrosis in the exfoliated buccal and palatal mucosa cells of children and adolescents using orthodontic appliances made of self-curing acrylic resins.

METHODS

The micronuclei and nuclear alterations were evaluated in a minimum of 2000 cells collected from the cheeks and palates of 30 patients of both sexes, aged between 6 and 12 years. The cell evaluations were performed before appliance installation and 15 to 21 days after installation. A conditional test was used. In all analyses, the significance level was 5%.

RESULTS

No differences in the occurrence of micronuclei or the nuclear degenerative changes indicative of apoptosis and necrosis were observed in the cheek cells between the 2 time points (P > 0.05). However, evaluation of the palate cells revealed a significant increase in the occurrence of micronuclei and the nuclear alterations indicative of apoptosis (P < 0.01) but not of karyolysis (P > 0.05).

CONCLUSIONS

Direct contact of orthodontic appliances made of acrylic resins with the oral mucosa increases the incidence of chromosomal damage and degenerative nuclear alterations.

Evaluation of genotoxic damage in buccal mucosa cytome assays in Iraqi school children exposed to air pollutants emanating from oil fields

Presently, over 135 thousand barrels of crude oil are extracted daily from the Al-ahdeb oil fields (situated at 180 km south east of Baghdad, Iraq). Millions of gallons of untreated toxic wastes, gas and crude oil are released into the environment. Oil mining mediated pollution may cause damage to humans and the environment. To investigate potential health risks for children living in this area, we recruited a sample of 6-8 year old school children residing within a 5 km radius around the oil field, and a control sample of children of the same age from a school 40 km away from the oil-field. Exfoliated buccal mucosa cells obtained from these children were analyzed applying the micronucleus (MN) cytome assay. Possible confounding variables such as x-rays performed during three weeks preceding sampling were obtained by a questionnaire. Nuclear anomalies were significantly elevated in children living near the oil-field. Micronucleated cells 1.3-fold, nuclear buds 3-folds, binucleated cells 3-folds, karyorrhetic cells 4-folds and karyolysis more than 10 folds with a significant difference (P < 0.05). Hence, children living in the proximity of Iraqi oil-fields are at elevated risk of genetic damage, which can cause detrimental health effects in the future.

Effects of scanning parameters reduction in dental radiographs on image quality and diagnostic performance: A randomised controlled trial

OBJECTIVES

To investigate the effect of reducing scanning parameters of digital dental panoramic tomogram (DPT) and lateral cephalometric (LC) radiographs on quality and diagnostic performance of the images.

DESIGN

Single-centre prospective two-arm parallel randomised controlled trial.

SETTING

Orthodontic Clinic, Faculty of Dentistry, Universiti Teknologi MARA, Selangor, Malaysia.

PARTICIPANTS

Adult orthodontic patients aged 18-35 years, indicated for DPT and LC, who were fit and healthy with a body mass index of 18.5-25.0, not contraindicated to radiographic examination, not pregnant, and did not have a history of facial or skeletal abnormalities or bone diseases were included.

METHODS

Thirty-eight adult orthodontic patients were randomised into control and intervention groups. DPT and LC radiographs in the control group were obtained using standard scanning parameters as prescribed by the manufacturer using Orthopantomograph® OP300 by Instrumentarium. Scanning parameters in the intervention group were reduced by 60% for DPT (60 kV, 3.2 mA) and 30% for LC (85 kV, 8 mA). A five-point rating scale was used for the assessment of image quality. Images were evaluated for diagnostic performance by detection of anatomical landmarks. Mann-Whitney test was performed to compare the quality and diagnostic performance of the images and the observer agreement was assessed using the intraclass correlation coefficient (ICC).

RESULTS

For image quality, the control group produced slightly lower median scores (DPT 2.0, LC 2.0) compared to the intervention group (DPT 2.0, LC 3.0). For diagnostic performance, both groups showed similar median scores (DPT 21.0, LC 32.0). The differences between control and intervention groups for both modalities were not statistically significant. The average scores for intra-observer agreement were excellent (ICC 0.917) and inter-observer agreement was good (ICC 0.822).

CONCLUSION

Minimising radiation exposure by reducing scanning parameters on digital DPT by 60% and LC by 30% on Intsrumentarium 300 OP did not affect the quality and diagnostic performance of the images. Thus, scanning parameters on digital DPT and LC should be reduced when taking radiographs.

The Genotoxic and Cytotoxic Effects of CT Scan on Buccal Epithelial Cells

Background:

Diagnostic radiation is reported to cause significant damage in buccal cells, while the same effects after natural cell turn over cycle were not checked for in previous studies. The buccal cells were studied in patients exposed to computed tomography (CT) scans for evaluating the cells with micronuclei and cytotoxic changes, namely, pyknotic cells, karyorrhectic cells and karyolytic cells. The pre-exposure counts were compared with postexposure counts on 10 and 20 days corresponding to first and second cell turnover cycles.

Aim:

The aim of this study is to estimate the counts of micronucleus and cytotoxic changes in buccal cells post-exposure to CT scans and report on variance of the same with first and second buccal cell turnover cycles.

Materials and Methods:

This is an observational study, wherein the buccal smears of patients undergoing CT scans were made before and after CT scan exposures as needed. Papanicolaou (PAP) staining and analysis were performed as per standard criteria for micronuclear and cytotoxic changes, respectively. Statistical test used was paired t-tests.

Results:

The micronuclear counts revealed 0.4% positive cells before exposure and 1.4% positive cells post 10 days and 20 days of exposure were significant (P < 0.005). The cytotoxic changes showed around 2.5% positive cells before and 5.7% positive cells 10 days after CT exposure (P < 0.005). The cytotoxic cell values from baseline to 20^th day were not significant (P < 0.25).

Conclusion:

CT scans have caused genotoxic effects notable after two cell turnover cycles but the cytotoxic changes have significantly decreased naturally after 2^nd cell turnover as per our study.

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effects of low-dose X-ray irradiation on activated macrophages and their possible signal pathways

Low-dose irradiation (LDI) has been used in clinics to treat human diseases, including chronic inflammation. This study assessed the effects of LDI on the inflammatory response of activated mouse primary peritoneal macrophages, and the underlying signal pathways. Primary peritoneal macrophages were isolated from mice and then incubated with lipopolysaccharide (LPS)-coated Ti microparticles (Ti-positive control) with or without brief exposure to LDI (X-ray, 0.5 Gy) 1 h later (Ti-LDI group) or left untreated in culture medium (Ti-negative control). The macrophages were then subjected to qRT-PCR, Western blot, cell viability CCK-8 assay, and ELISA. qRT-PCR analysis revealed the Ti-LDI group expressed significantly lower levels of IL-1β, IL-6, and TNF-α mRNA than those of the Ti-positive control group, while the ELISA data showed that Ti-LDI group had significantly lower secretion of IL-1β, IL-6, and TNF-α proteins. The most significant reduction associated with LDI was the secretion TNF-α protein, which barely increased from 13 to 25 h after treatment. Western blot data demonstrated that phosphorylation of p65 and ERK was much lower in the Ti-LDI group than in the controls. The data from the current study suggests that LDI of activated mouse macrophages was associated with significantly lower inflammation responses, compared with non-exposed activated macrophages, which was possibly through inhibition of the NF-κB and ERK pathways.

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

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

Oxidative stress and glutathione S-transferase genetic polymorphisms in medical staff professionally exposed to ionizing radiation

PURPOSE

Ionizing radiation (IR) is considered as a diagnostic and therapeutic tool in medicine. However, chronic occupational exposure of medical staff to IR may affect the antioxidant status and, as a result, DNA damage and cancers as well. The objective of our study was to evaluate the oxidative stress profile caused by IR in 29 Tunisian medical staff from radiology and radiotherapy departments, and to find an association between the GSTM1 null, GSTT1 null, and GSTP1 Ile105Val polymorphisms and oxidative stress biomarkers.

MATERIALS AND METHODS

The oxidant biomarkers malondialdehyde (MDA) and advanced oxidation protein product (AOPP) and the activities of the antioxidant superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) enzymes were spectrophotometrically determined in erythrocytes hemolysates. The analysis of GSTT1 null, GSTM1 null, and GSTP1 Ile105Val polymorphisms was determined for each participant using PCR methods.

RESULTS

A significant increase of white blood cell (WBC) numbers (p < .05) and a significant decrease by 11% of hemoglobin (Hb) (p < .01) were noted in the exposed subjects in our study. Moreover, we report a significant increase of MDA level and the activities of SOD and CAT enzymes of the IR-exposed group compared to controls (p < .001). Interestingly, a close association was noted between the genotypes GSTP1 low active, GSTT1 null, GSTM1 null, and both GSTT1/GSTM1 null and oxidative stress biomarkers, especially with MDA level, SOD, and CAT activities.

CONCLUSIONS

Our findings indicate that the medical staff exposed to low IR levels were under risk of significant oxidative stress that was enhanced by their glutathione S-transferase (GST) polymorphisms.

Cytogenetic biomonitoring in individuals exposed to cone beam CT: comparison among exfoliated buccal mucosa cells, cells of tongue and epithelial gingival cells

OBJECTIVES

To evaluate chromosomal damage and cytotoxicity in exfoliated buccal mucosa cells, cells of the tongue and epithelial gingival cells from adults following CBCT scan and to compare the sensitivity of the different exfoliated cells to a same dosage of ionizing radiation.

METHODS

The study included 46 healthy participants (median age 27 years; age range 23-42 years) who had a CBCT scan. Exfoliated mucosa cells were collected immediately before the CBCT scan and 10 days after. Cells were centrifuged, fixed in the fluid of methanol : glacial acetic acid (3 : 1) and stained using the method of Schiff's reagent and fast green. One observer analyzed all the slides. For interobserver variances, a second observer scored 16 slides chosen from all the subjects. The same set of 16 slides were analyzed once again a month later for intraobserver variances.

RESULTS

There is no significant differences for micronucleated cells before and after a CBCT scan in exfoliated buccal mucosa cells (p = 0.476), cells of the tongue (p = 0.884) and epithelial gingival cells (p = 0.362). The frequencies of pyknosis cell and karyolysis cell had significantly increased after CBCT scan in the three groups. No significant difference was found among the three kinds of mucosa cells (p = 0.557). The interobserver (p = 0.624) and intraobserver (p = 0.193) variances were not significant.

CONCLUSIONS

A CBCT scan may induce cytotoxicity but not chromosomal damage in the oral mucosa cells, including buccal mucosa cells, cells of the tongue or epithelial gingival cells. The sensitivity of the different exfoliated cells to the same dosage of radiation had no statistically significant difference.

Could formaldehyde induce mutagenic and cytotoxic effects in buccal epithelial cells during anatomy classes?

Background

Due to increased formaldehyde exposure, carcinogenic to humans, several researches have been studying the potential toxicity and the safe levels for human beings. The aim of this study was to investigate mutagenicity and cytotoxicity in buccal epithelial exfoliated cells (BEC) of students subjected to formaldehyde (FA) during anatomy classes.

Material and Methods

BEC were collected periodically from 17 volunteers of undergraduate programs, who had participated in practical anatomy classes, before and after FA exposure. Cells were stained according to Feulgen method and then micronucleus test was applied. A total of 1,500 cells were assessed per individual in this study for the micronucleus frequency and other parameters of cytotoxicity.

Results

There was statistically significant increase in number of micronucleated BEC after FA exposure (after 1 month p=.034 and after 3.5 months p=.017). However, FA exposure caused no significant increase in other nuclear alterations closely related to cytotoxicity (p≥.05).

Conclusions

FA induced mutagenicity during anatomy classes. Cell death increased, but it was not statistically significant. Efforts have to be made to improve air quality and reduce exposures during anatomy classes.

Key words:Carcinogens, formaldehyde, micronucleus tests, mutagenicity tests.

Caries Experience among Adults Exposed to Low to Moderate Doses of Ionizing Radiation in Childhood - The Tinea Capitis Cohort

While the impact of therapeutic levels of ionizing radiation during childhood on dental defects has been documented, the possible effect of low doses on dental health is unknown. The study aim was to assess the association between childhood exposure to low-moderate doses of therapeutic radiation and caries experience among a cohort of adults 50 years following the exposure. The analysis was based on a sample of 253 irradiated (in the treatment of tinea capitis) and 162 non-irradiated subjects. The decayed, missing, and filled teeth (DMFT) index was assessed during a clinical dental examination and questions regarding dental care services utilization, oral hygiene behavior, current self-perceived mouth dryness, socio-demographic parameters, and health behavior variables were obtained through a face-to-face interview. An ordered multivariate logistic regression model was used to assess the association of the main independent variable (irradiation status) and other relevant independent variables on the increase in DMFT. Mean caries experience levels (DMFT) were 18.6 ± 7.5 for irradiated subjects compared to 16.4 ± 7.2 for the non-irradiated (p = 0.002). Controlling for gender, age, education, income, smoking, dental visit in the last year, and brushing teeth behavior, irradiation was associated with a 72% increased risk for higher DMFT level (95% CI: 1.19-2.50). A quantification of the risk by dose absorbed in the salivary gland and in the thyroid gland showed adjusted ORs of 2.21 per 1 Gy (95% CI: 1.40-3.50) and 1.05 per 1 cGy (95% CI: 1.01-1.09), respectively. Childhood exposure to ionizing radiation (0.2-0.4 Gy) might be associated with late outcomes of dental health. In line with the guidelines of the American Dental Association, these results call for caution when using dental radiographs.

Biomonitoring of Buccal Mucosa Cells in Chronic Smokers and Nonsmokers

Background

Despite the well-known presence of carcinogens in tobacco smoke, results in the scientific literature linking smoking habits to micronuclei frequency are rather controversial.

Aim

The study was conducted to compare and evaluate the frequency of micronuclei in chronic smokers and nonsmokers in relation to habit history, personal history, and other related factors like occupation, exposure to radiation, etc.

Materials and methods

A total of 50 randomly selected male subjects were included in the study. Case and control groups (smokers and nonsmokers respectively) comprised 25 subjects each (mean age in controls = 38.24 ± 2.7; mean age in smokers = 39.32 ± 3.8).

Results and conclusion

There was a significant relation between tobacco consumption and frequency of micronucleated cells (p = 0.05) and between radiation exposure and presence of micronuclei (p = 0.05) in controls and subjects. Within the smokers group, left cheek scrapings showed higher count (p = 0.05; significant) for the micronucleated cells as compared with right cheek scrapings.

Clinical significance

In this study, an attempt was made to estimate the cytogenetic damage in oral mucosa in people habituated to smoking beedi. Though tobacco plays an important role in micronuclei generation, other factors like ionizing radiation and personal habits also contribute to micronuclei frequency. Site of smear, sample size, nuclear specific stain usage are some of the contributing factors. In addition, cytogenetic alterations like karyolysis, pyknosis, etc., can be included in future studies to increase the specificity.

How to cite this article

Sarpal RS, Taneja N, Shergill NK, Ravindra SV. Biomonitoring of Buccal Mucosa Cells in Chronic Smokers and Nonsmokers. World J Dent 2016;7(4):189-194.

Long-Term Effects of Exposure to Ionizing Irradiation on Periodontal Health Status - The Tinea capitis Cohort Study

Studies among long-term survivors of childhood cancer who had received high-dose irradiation therapy of 4–60 Gy, demonstrated acute and chronic dental effects, including periodontal diseases. However, the possible effects of low to moderate doses of radiation on dental health are sparse. The aim of this study is to investigate the association between childhood exposure to low–moderate doses of ionizing radiation and periodontal health following 50 years since exposure. The study population included 253 irradiated subjects (treated for Tinea capitis in the 1950s) and, 162 non-irradiated subjects. The estimated dose to the teeth was 0.2–0.4 Gy. Dental examination was performed according to the community periodontal index (CPI). Socioeconomic and health behavior variables were obtained through a personal questionnaire. Periodontal disease was operationally defined as “deep periodontal pockets.” A multivariate logistic regression model was used for the association of irradiation status and other independent variables with periodontal status. The results showed that among the irradiated subjects, 23%, (95% CI 18–28%) demonstrated complete edentulousness or insufficient teeth for CPI scoring as compared to 13% (95% CI 8–19%) among the non-irradiated subjects (p = 0.01). Periodontal disease was detected among 54% of the irradiated subjects as compared to 40% of the non-irradiated (p = 0.008). Controlling for education and smoking, the ORs for the association between radiation and periodontal disease were 1.61 (95% CI 1.01–2.57) and 1.95 (95% CI 1.1–3.5) for ever never and per 1 Gy absorbed in the salivary gland, respectively. In line with other studies, a protective effect for periodontal diseases among those with high education and an increased risk for ever smokers were observed. In conclusion, childhood exposure to low-moderate doses of ionizing radiation might be associated with later outcomes of dental health. The results add valuable data on the long-term health effects of exposure to ionizing radiation and support the implementation of the ALARA principle in childhood exposure to diagnostic procedure involving radiation.

Role of micronucleus in oral exfoliative cytology

In the last few years, the interest for oral cytology as a diagnostic and prognostic methodology, for monitoring patients in oral potentially malignant disorders and oral cancer has re-emerged substantially. In 1983, buccal mucosal micronuclei assay was first proposed to evaluate genetic instability. There are biomarkers that predict if a potentially malignant disorder is likely to develop into an aggressive tumor. These genotoxic and carcinogenic chemicals have been reported to be potent clastogenic and mutagenic agents which are thought to be responsible for the induction of chromatid/chromosomal aberrations resulting in the production of micronuclei. Various studies have concluded that the gradual increase in micronucleus (MN) counts from normal oral mucosa to potentially malignant disorders to oral carcinoma suggested a link of this biomarker with neoplastic progression. MN scoring can be used as a biomarker to identify different preneoplastic conditions much earlier than the manifestations of clinical features and might specifically be exploited in the screening of high-risk population for a specific cancer. Hence, it can be used as a screening prognostic and educational tool in community centers of oral cancer.

Chromosomal damage and apoptosis analysis in exfoliated oral epithelial cells from mouthwash and alcohol users

Chromosomal damage and apoptosis were analyzed in users of mouthwash and/or alcoholic beverages, using the micronucleus test on exfoliated oral mucosa cells. Samples from four groups of 20 individuals each were analyzed: three exposed groups (EG1, EG2 and EG3) and a control group (CG). EG1 comprised mouthwash users; EG2 comprised drinkers, and EG3 users of both mouthwashes and alcoholic beverages. Cell material was collected by gently scraping the insides of the cheeks. Then the cells were fixed in a methanol/acetic acid (3:1) solution and stained and counterstained, respectively, with Schiff reactive and fast green. Endpoints were computed on 2,000 cells in a blind test. Statistical analysis showed that chromosomal damage and apoptosis were significantly higher in individuals of groups EG1 and EG3 than in controls (p < 0.005 and p < 0.001, respectively). No significant difference in chromosomal damage and apoptosis was observed between the exposed groups. In EG2, only the occurrence of apoptosis was significantly higher than in the controls. These results suggest that mouthwashes alone or in association with alcoholic drinks induce genotoxic effects, manifested as chromosomal damage and apoptosis. They also suggest that alcoholic drinks are effective for stimulating the process of apoptosis. However, these data need to be confirmed in larger samples.

Evaluation of the genotoxicity and cytotoxicity in the buccal epithelial cells of patients undergoing orthodontic treatment with three light-cured bonding composites by using micronucleus testing

Objective

This study evaluated the cytotoxicity and genotoxicity of fixed orthodontic treatment with three different light-cured orthodontic bonding composites by analyzing micronucleus (MN) formation in the buccal mucosa during a 6-month period.

Methods

Thirty healthy volunteers were selected from consecutive patients referred for orthodontic treatment. Equilibrium 2 brackets and molar tubes (Dentaurum) were bonded with three different light-cured orthodontic bonding composites-Transbond XT (3M Unitek), Kurasper F (Kuraray Europe), or GrenGloo (Ormco Corporation)- to all teeth in both arches. Exfoliated buccal epithelial cells were scraped from the middle part of the inner cheeks with sterile cement spatulas before treatment and at 1, 3, and 6 months after treatment. MNs and nuclear alterations, such as karyorrhexis (KR), karyolysis (KL), and binucleated cells (BNs), were scored under a light microscope. Repeated measure ANOVA was used to calculate statistical differences in degenerative nuclear abnormalities.

Results

MN rates did not significantly differ among different time points within the same cell type (p > 0.05). In contrast, the number of BNs in buccal epithelial cells significantly increased in all composite groups (p < 0.01, Transbond XT; p < 0.001, Kurasper F and GrenGloo). KL frequency significantly increased between the beginning and end of the study in the Kurasfer F (0.80 ± 0.79 to 1.90 ± 1.10; p < 0.05) and GrenGloo (1.30 ± 1.06 to 2.40 ± 1.08; p < 0.05) groups.

Conclusions

After 6 months of fixed orthodontic treatment with different light-cured composites, morphological signs of cytotoxicity were observed but genotoxic effects were absent.

Comparison of clinical and dental panoramic findings: a practice-based crossover study

BACKGROUND

Aim was to compare clinical findings with x-ray findings using dental panoramic radiography (DPR). In addition, type and frequency of secondary findings in x-rays were investigated.

METHODS

Patients were selected on the basis of available DPRs (not older than 12 months). No therapeutic measures were permitted between the DPR and the clinical findings. The clinical findings were carried out by several investigators who had no knowledge of the purpose of the study. A calibrated investigator established the x-ray findings, independently and without prior knowledge of the clinical findings. The evaluation parameters for each tooth were: missing, healthy, carious, restorative or prosthetically sufficient or insufficient treatment. Type and frequency of additional findings in the DPR were documented, e.g. quality of a root canal filling and apical changes.

RESULTS

Findings of 275 patients were available. Comparison showed a correspondence between clinical and radiographic finding in 93.6% of all teeth (n = 7,789). The differences were not significant (p > 0.05). Regarding carious as well as insufficiently restored or prosthetically treated teeth, respectively there were significant differences between the two methods (p < 0.05). The DPRs showed additional findings: root fillings in 259 teeth and 145 teeth with periapical changes.

CONCLUSIONS

With reference to the assessment of teeth, there was no difference between the two methods. However, in the evaluation of carious as well as teeth with insufficiently restorative or prosthetic treatment, there was a clear discrepancy between the two methods. Therefore, it would have been possible to have dispensed with x-rays. Nevertheless, additional x-ray findings were found.

Mutagenicity and cytotoxicity in patients submitted to ionizing radiation

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Cytogenetic biomonitoring in oral mucosa cells following dental X-ray

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Cone-beam computed tomography and radiographs in dentistry: aspects related to radiation dose

Introduction. The aim of this study was to discuss the radiation doses associated with plain radiographs, cone-beam computed tomography (CBCT), and conventional computed tomography (CT) in dentistry, with a special focus on orthodontics. Methods. A systematic search for articles was realized by MEDLINE from 1997–March 2011. Results. Twenty-seven articles met the established criteria. The data of these papers were grouped in a table and discussed. Conclusions. Increases in kV, mA, exposure time, and field of view (FOV) increase the radiation dose. The dose for CT is greater than other modalities. When the full-mouth series (FMX) is performed with round collimation, the orthodontic radiographs transmit higher dose than most of the large FOV CBCT, but it can be reduced if used rectangular collimation, showing lower effective dose than large FOV CBCT. Despite the image quality, the CBCT does not replace the FMX. In addition to the radiation dose, image quality and diagnostic needs should be strongly taken into account.

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Chemical genoprotection: reducing biological damage to as low as reasonably achievable levels

OBJECTIVES

The aim of this study was to evaluate the antioxidant substances present in the human diet with an antimutagenic protective capacity against genotoxic damage induced by exposure to X-rays in an attempt to reduce biological damage to as low a level as reasonably possible.

METHODS

Ten compounds were assessed using the lymphocyte cytokinesis-block micronucleus (MN) cytome test. The compounds studied were added to human blood at 25 μM 5 min before exposure to irradiation by 2 Gy of X-rays.

RESULTS

The protective capacity of the antioxidant substances assessed was from highest to lowest according to the frequency of the MN generated by X-ray exposure: rosmarinic acid = carnosic acid = δ-tocopherol = l-acid ascorbic = apigenin = amifostine (P < 0.001) > green tea extract = diosmine = rutin = dimetylsulfoxide (P < 0.05) > irradiated control. The reduction in genotoxic damage with the radiation doses administered reached 58%, which represents a significant reduction in X-ray-induced chromosomal damage (P < 0.001). This degree of protection is greater than that obtained with amifostine, a radioprotective compound used in radiotherapy and which is characterised by its high toxicity.

CONCLUSION

Several antioxidant substances, common components of the human diet and lacking toxicity, offer protection from the biological harm induced by ionizing radiation. Administering these protective substances to patients before radiological exploration should be considered, even in the case of small radiation doses and regardless of the biological damage expected.

Detection of lung cancer by oral examination

Lung cancer continues to be the leading cause of cancer deaths worldwide. Cigarette smoking is the predominant cause of lung cancer. Researchers found that tobacco-induced molecular changes in the oral epithelium are similar to those in the lung epithelium. Furthermore, there has been considerable progress in investigating the tumorigenesis of oral epithelium using molecular markers. These results offer hope that we can predict lung cancer in smokers by oral examination, which is much easier and more practical than lung biopsy. The hypothesis is to collect oral epithelial cells by gently scraping the oral mucosa, and analyze the DNA variation in these cells using molecular biological methods. Therefore, the oral epithelium is serving as a surrogate tissue for assessing smoking-induced molecular damage to the lungs and thus have important implications for early detection of lung cancer.