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Katz J, Ensz OS, Rotstein I. Prevalence of acute periapical abscesses in head and neck cancer patients receiving radiotherapy. SPECIAL CARE IN DENTISTRY 2024; 44:946-951. [PMID: 38183165 DOI: 10.1111/scd.12952] [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: 08/07/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024]
Abstract
AIMS Head and neck cancer is a serious condition affecting the life of patients. Radiotherapy is commonly used to treat such conditions. The aim of this study was to assess the prevalence of acute periapical abscesses (PAs) in patients who received radiotherapy for head and neck cancer. METHODS AND RESULTS Data on acute PAs and oropharyngeal cancer (OPC) diagnosis with or without a history of radiation therapy (RAD) was retrieved by searching the appropriate query in the database. All cases were diagnosed for acute PAs by calibrated dentists for patients admitted to urgent care. The odds ratio (OR) for the prevalence of acute PAs and its association with a history of OPC with or without RAD were then calculated. Adjustment for comorbidities such as diabetes, smoking and gingival and periodontal diseases was also done. The prevalence of acute PAs in patients with a history of OPC was significantly higher as compared to the general hospital patient population (OR 2.92, 95%CI, p < .0001). Males were more affected than females and whites were more affected than African Americans and other ethnicities. The prevalence for PAs in patients with a history of OPC and RAD was higher and the difference in prevalence was statistically significant (OR 3.61, 95%CI, p < .0001). Whites were more affected than African Americans by more than 3.5-fold. Adjustment for diabetes comorbidly affected mainly the OPC + RAD group, however, the difference remained statistically significant. Adjustment for smoking and gingival and periodontal disease reduced the OR but the difference remained statistically different. CONCLUSIONS The high prevalence of acute PAs in patients with a history of OPC and RAD may suggest an association between these conditions warranting a meticulous medical and dental examination.
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Affiliation(s)
- Joseph Katz
- Department of Oral Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Olga S Ensz
- Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Ilan Rotstein
- Department of Endodontics and Periodontics, University of Southern California, Los Angeles, California, USA
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Santana MLL, Ribeiro TE, Silva JA, de Alencar AHG, Novais VR, Estrela C, Decurcio DDA. Does irradiation of the tooth structure interfere with oxygen saturation measured by pulse oximetry?-An ex vivo laboratorial study. AUST ENDOD J 2023; 49 Suppl 1:419-425. [PMID: 37036185 DOI: 10.1111/aej.12758] [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: 11/21/2022] [Revised: 02/16/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
The effect of tooth structure subjected to ionising radiation on oxygen saturation levels (SpO2 ) measured by pulse oximetry was investigated. Fifty-four extracted human third molars were sectioned mesiodistally. Pulse oximeter diodes were placed in prefabricated silicone moulds, secured on a vise with tooth surfaces placed between the diodes and the participant's finger, and SpO2 levels were measured. After that, the tooth surfaces were subjected to ionising radiation in fractionated doses of up to 70 Gy, and SpO2 was measured according to the protocol described. The Kolmogorov-Smirnov test was used for the analysis of normality of the quantitative variables, and Student's t-test compared mean SpO2 levels before and after irradiation. Mean SpO2 after irradiation was 94.6 ± 0.9%, without a statistically significant difference from SpO2 before irradiation, which was 94.7 ± 0.6%. Irradiation of the tooth structure did not interfere with SpO2 levels measured by pulse oximetry.
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Affiliation(s)
| | | | | | | | | | - Carlos Estrela
- Faculdade de Odontologia, Universidade Federal de Goiás, Goiânia, Brazil
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Ribeiro TE, Novais VR, Estrela C, Santana MLL, Rossi-Fedele G, Decurcio DDA. Does radiotherapy treatment alter the pulp condition in patients with head and neck cancer? A systematic review. Braz Oral Res 2023; 37:e079. [PMID: 37531515 DOI: 10.1590/1807-3107bor-2023.vol37.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/06/2023] [Indexed: 08/04/2023] Open
Abstract
The main purpose of this study was to answer the question: "Can radiotherapy cause changes in the dental pulp condition of patients treated with irradiation in the head and neck region?" Clinical observational studies in adults with head and neck cancer undergoing treatment with ionizing radiation, longitudinal or cross-sectional follow-up to measure oxygen saturation (SpO2), and/or pulp sensitivity test to cold stimulation, were considered eligible. A systematic literature search was performed in six different databases, including the gray literature, and in article references. Two independent evaluators selected the studies, extracted the data, recorded the data on electronic spreadsheets, and then evaluated the methodological quality using the Checklist for Quasi-Experimental Studies tool devised by JBI. The data were assessed qualitatively using the Synthesis Without Metanalysis (SWiM) guidelines. After removing the duplicate articles, carefully analyzing the titles and abstracts, and reading the papers in full, seven studies were included. Four of the studies evaluated applied the cold sensitivity test, two associated pulse oximetry and cold sensitivity, and only one used just pulse oximetry. Evaluation using the cold sensitivity test and pulse oximetry in the initial periods before radiotherapy showed a decrease in the sensitive response and in SpO2 levels during a maximum period of 1 year. However, analyses thereafter indicated a normal response in both tests from 5 to 6 years after the end of radiotherapy treatment. Radiotherapy causes changes in pulp behavior patterns in the short term; however, recovery and return to average values occurs after long periods.
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Affiliation(s)
- Thalles Eduardo Ribeiro
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Science, Goiânia, GO, Brazil
| | - Veridiana Resende Novais
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Dentistry and Dental Materials, Uberlândia, MG, Brazil
| | - Carlos Estrela
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Science, Goiânia, GO, Brazil
| | - Maria Luiza Lima Santana
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Science, Goiânia, GO, Brazil
| | - Giampiero Rossi-Fedele
- University of Adelaide, Adelaide Dental School, Department of Endodontics, Adelaide, South Australia, Australia
| | - Daniel de Almeida Decurcio
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Science, Goiânia, GO, Brazil
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Weissheimer T, Só BB, Pradebon MC, de Figueiredo JAP, Martins MD, Só MVR. Head and neck radiotherapy effects on the dental pulp vitality and response to sensitivity tests. A systematic review with meta-analysis. Int Endod J 2022; 55:563-578. [PMID: 35298027 DOI: 10.1111/iej.13726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is no consensus whether radiotherapy for head and neck cancer (HNC) could induce pulp necrosis. Therefore, a systematic review of clinical studies is necessary. OBJECTIVES To evaluate the evidences on radiotherapy for HNC and pulp status. METHODS A systematic search of articles published until November 2021 was performed in the MEDLINE/PubMed, Cochrane Library, Web of Science (All Databases), Scopus, EMBASE and Open Grey databases. The eligibility criteria were based on the PICOS strategy, as follows: (P) vital teeth of adult patients with intraoral and/or oropharyngeal cancer; (I) radiotherapy; (C) control group or values of the same tooth before radiotherapy (basal values); (O) pulpal status after radiotherapy; (S) clinical studies. The Cochrane Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool was used to assess the quality of the included studies. Meta-analyses were performed using fixed and random effects. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS Six studies were included for qualitative analysis. Five were classified as serious risk of bias and one as moderate risk of bias. Four studies reported altered pulp responses to cold thermal test after radiotherapy initiation. Meta-analyses were performed using three included studies. From these, all were included in the meta-analysis for pulp response values to cold sensitivity test immediately after radiotherapy initiation (risk ratio: 0.00[CI:0.00, 0.02], P < 0.00001; I2 = 0%); and two in the meta-analysis for pulp response values to cold sensitivity test after 4-5 months of radiotherapy (risk ratio: 0.01[CI: 0.00. 0.06], P < 0.00001; I2 = 0%). Two reported progressively higher readings to pulp response in the electrical test after radiotherapy initiation (mean difference: -11.46[-13.09, -9.84], P < 0.00001; I2 = 68%) and at all periods evaluated. Two studies demonstrated a pulp oxygen saturation (SpO2 ) decrease at the end of radiotherapy; and increase after 4-6 months of radiotherapy beginning. And other demonstrated normal dental pulp SpO2 4 to 6 years after treatment. GRADE analysis presented a moderate certainty of evidence. DISCUSSION This review verified that radiotherapy for HNC causes significant alterations on the dental pulp responses, but does not seem to induce pulp necrosis. Significant limitations regarding controlling for confounding factors, classification of interventions and measurement of outcomes were verified, evidencing the need for well-designed studies. CONCLUSIONS This systematic review demonstrated that radiotherapy for HNC induced significant changes in the pulp response with moderate quality of evidence. Such altered responses cannot determine pulp status accurately.
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Affiliation(s)
- Theodoro Weissheimer
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Bruna Barcelos Só
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Marieli Chitolina Pradebon
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | | | - Manoela Domingues Martins
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Marcus Vinicius Reis Só
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
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Najafi M, Cheki M, Hassanzadeh G, Amini P, Shabeeb D, Musa AE. Protection from Radiation-induced Damage in Rat's Ileum and Colon by Combined Regimens of Melatonin and Metformin: A Histopathological Study. Antiinflamm Antiallergy Agents Med Chem 2021; 19:180-189. [PMID: 31438832 PMCID: PMC7475942 DOI: 10.2174/1871523018666190718161928] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/22/2019] [Accepted: 06/28/2019] [Indexed: 01/07/2023]
Abstract
Background: Radiation-induced enteritis and proctitis are common side effects of abdominopelvic cancers among patients that undergo radiotherapy for prostate, colorectal or urinary cancers. Exposure of these tissues to high doses of radiation leads to damage to villous, inflammation, pain, ulcer and bleeding, which may cause malabsorption and gastrointestinal disorders. To date, several procedures such as pharmaceutical treatment have been proposed for protection and mitigation of gastrointestinal toxicity following radiotherapy. Aims: In the current study, we aimed to investigate the possible radioprotection of ileum and colon in rats using a combination of melatonin and metformin. Methods: In this experimental study, 30 male Wistar rats were randomly assigned to six groups: control, melatonin (100 mg/kg) treatment, melatonin (100 mg/kg) plus metformin (100 mg/kg) treatment, radiation (10 Gy to whole body) group, radiation + melatonin (100 mg/kg) treatment, and radiation + melatonin (100 mg/kg) plus metformin (100 mg/kg) treatment. After 3.5 days, rats were sacrificed and their ileum and colon tissues carefully removed. Histopathological evaluations were conducted on these tissue samples. Results: Histological evaluations reported moderate to severe damages to ileum and colon following whole body irradiation. Melatonin administration was able to protect the ileum remarkably, while the combination of melatonin and metformin was less effective. Interestingly, for the colon, melatonin was less effective while its combination with metformin was able to protect against radiation toxicity completely. Conclusion: For the ileum, melatonin was a more effective radioprotector compared to its combination with metformin. However, the combination of melatonin and metformin can be proposed as an ideal radioprotector for the colon.
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Affiliation(s)
- Masoud Najafi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Cheki
- Cancer Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gholamreza Hassanzadeh
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Amini
- Department of Radiology, Faculty of Paramedical, Tehran University of Medical Sciences, Tehran, Iran
| | - Dheyauldeen Shabeeb
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science, International Campus, Tehran, Iran.,Department of Physiology, College of Medicine, University of Misan, Misan, Iraq
| | - Ahmed E Musa
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Science, International Campus, Tehran, Iran.,Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
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Farhood B, Hassanzadeh G, Amini P, Shabeeb D, Musa AE, Khodamoradi E, Mohseni M, Aliasgharzadeh A, Moradi H, Najafi M. Mitigation of Radiation-induced Gastrointestinal System Injury using Resveratrol or Alpha-lipoic Acid: A Pilot Histopathological Study. Antiinflamm Antiallergy Agents Med Chem 2020; 19:413-424. [PMID: 31713500 DOI: 10.2174/1871523018666191111124028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/05/2019] [Accepted: 10/20/2019] [Indexed: 06/10/2023]
Abstract
AIM In this study, we aimed to determine possible mitigation of radiationinduced toxicities in the duodenum, jejunum and colon using post-exposure treatment with resveratrol and alpha-lipoic acid. BACKGROUND After the bone marrow, gastrointestinal system toxicity is the second critical cause of death following whole-body exposure to radiation. Its side effects reduce the quality of life of patients who have undergone radiotherapy. Resveratrol has an antioxidant effect and stimulates DNA damage responses (DDRs). Alpha-lipoic acid neutralizes free radicals via the recycling of ascorbic acid and alpha-tocopherol. OBJECTIVE This study is a pilot investigation of the mitigation of enteritis using resveratrol and alpha-lipoic acid following histopathological study. METHODS 60 male mice were randomly assigned to six groups; control, resveratrol treatment, alpha-lipoic acid treatment, whole-body irradiation, irradiation plus resveratrol, and irradiation plus alpha-lipoic acid. The mice were irradiated with a single dose of 7 Gy from a cobalt-60 gamma-ray source. Treatment with resveratrol or alpha-lipoic acid started 24 h after irradiation and continued for 4 weeks. All mice were sacrificed after 30 days for histopathological evaluation of radiation-induced toxicities in the duodenum, jejunum and colon. RESULTS AND DISCUSSION Exposure to radiation caused mild to severe damages to vessels, goblet cells and villous. It also led to significant infiltration of macrophages and leukocytes, especially in the colon. Both resveratrol and alpha-lipoic acid were able to mitigate morphological changes. However, they could not mitigate vascular injury. CONCLUSION Resveratrol and alpha-lipoic acid could mitigate radiation-induced injuries in the small and large intestine. A comparison between these agents showed that resveratrol may be a more effective mitigator compared to alpha-lipoic acid.
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Affiliation(s)
- Bagher Farhood
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Gholamreza Hassanzadeh
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Amini
- Department of Radiology, Faculty of Paramedical, Tehran University of Medical Sciences, Tehran, Iran
| | - Dheyauldeen Shabeeb
- Department of Physiology, College of Medicine, University of Misan, Misan, Iraq
| | - Ahmed Eleojo Musa
- Department of Medical Physics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Khodamoradi
- Department of Radiology and Nuclear Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehran Mohseni
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Akbar Aliasgharzadeh
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Habiballah Moradi
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Masoud Najafi
- Department of Radiology and Nuclear Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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