Radiation-related caries: current diagnostic, prognostic, and management paradigms

Author(s)

Palmier, Natalia Rangel ^[1] ; Migliorati, Cesar Augusto ^[2] ; Prado-Ribeiro, Ana Carolina ^[3] ; Querido de Oliveira, Maria Cecilia ^[3] ; Vechiato Filho, Aljomar Jose ^[3] ; de Goes, Mario Fernando ^[4] ; Brandao, Thais Bianca ^[3] ; Lopes, Marcio Ajudarte ^[1] ; Santos-Silva, Alan Roger ^[1]

Affiliation

^[1] Univ Estadual Campinas, Piracicaba Dent Sch, Oral Diag, Piracicaba, SP - Brazil

^[2] Univ Florida, Coll Dent, Gainesville, FL - USA

^[3] ICESP FMUSP, Dent Oncol Serv, Sao Paulo State Canc Inst, Sao Paulo, SP - Brazil

^[4] Univ Estadual Campinas, Restorat Dent Dept, Piracicaba Dent Sch, Piracicaba, SP - Brazil

• Document type: Journal article
• Source: ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY ORAL RADIOLOGY; v. 130, n. 1, p. 52-62, JUL 2020.
• Web of Science Citations: 0

Abstract

Objective and study design. This narrative review summarizes the current state of art of radiation-related caries (RC), an aggressive disease that affects approximately 30% of post-head and neck radiotherapy (HNRT) patients. Results. RC mainly affects the tooth cervical areas and incisal/cuspal tips and develops 6 to 12 months after HNRT. Early RC signs include black/brownish tooth discoloration and enamel cracks, which progress to enamel delamination, exposing underlying dentin to a highly cariogenic oral environment and rapid tooth destruction/dental crown amputation. As RC advances and renders the tooth nonrestorable, it may lead to osteoradionecrosis spontaneously or upon extraction if the tooth is in a highly irradiated field of the oral cavity. This requires aggressive treatment, which would have a negative impact on a cancer survivor's quality of life and contribute to the incremental cost of cancer care. Chlorhexidine mouth rinses and topical fluoride applications are effective agents used in RC prevention; however, there are no well-established treatment protocols. Once RC progresses, dental restorations should be performed with adhesive materials in association with systematic fluoride application as illustrated in the clinical case presented in this review. Post-HNRT patients should be closely followed up for optimal RC prevention, early diagnosis, and prompt treatment. Conclusions. Future clinical studies are necessary to establish a contemporary, clinically validated protocol for RC management. (AU)

• FAPESP's process: 18/02233-6 - Oncological safety of the use of intraoral and extraoral photobiomodulation in patients with oral cavity and oropharyngeal squamous cell carcinoma
• Grantee: Alan Roger dos Santos Silva
• Support Opportunities: Regular Research Grants
• FAPESP's process: 12/06138-1 - A prospective study of radiation-induced trismus in patients with oral squamous cell carcinoma
• Grantee: Ana Carolina Prado Ribeiro e Silva
• Support Opportunities: Regular Research Grants
• FAPESP's process: 13/18402-8 - Evaluation of the direct effects of radiation on the enamel, dentin and dental pulp of head and neck cancer patients
• Grantee: Alan Roger dos Santos Silva
• Support Opportunities: Regular Research Grants
• FAPESP's process: 16/22862-2 - Impact of age in radiation-induced oral toxicities of young patients with oral cancer
• Grantee: Jaqueline de Lima Correia
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• FAPESP's process: 18/04657-8 - Salivary protein markers of radiation-related oral toxicites
• Grantee: Natália Rangel Palmier
• Support Opportunities: Scholarships in Brazil - Doctorate