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.
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References
- Induction chemotherapy for oral cavity cancer patients: current status and future perspectives.Oral Oncol. 2015; 51: 1069-1075
- Patterns of demineralization and dentin reactions in radiation-related caries.Caries Res. 2009; 43: 43-49
- Dental lesions observed after roentgen therapy in cancer of the buccal cavity, pharynx and larynx.Am J Roentgenol. 1939; 40: 404-410
- A systematic review of dental disease in patients undergoing cancer therapy.Support Care Cancer. 2010; 18: 1007-1021
- The impact of radiation caries in the quality of life of head and neck cancer patients.Support Care Cancer. 2020; 28: 2977-2984
- Radiation-related caries assessment through the International Caries Detection and Assessment System and the Post-Radiation Dental Index.Oral Surg Oral Med Oral Pathol Oral Radiol. 2017; 124: 542-547
- Costs of oral complications of cancer therapies: estimates and a blueprint for future study.J Natl Cancer Inst Monogr. 2019; 2019: lgz010
National Institute of Dental and Craniofacial Research. Dental caries (tooth decay) in adults (age 20 to 64). Available at: https://www.nidcr.nih.gov/research/data-statistics/dental-caries/adults. Accessed January 5, 2020.
- Oral health status of 207 head and neck cancer patients before, during and after radiotherapy.Clin Oral Investig. 2008; 12: 19-24
- Dental disease before radiotherapy in patients with head and neck cancer: Clinical registry of dental outcomes in head and neck cancer patients.J Am Dent Assoc. 2017; 148: 868-877
- cGVHD-related caries and its shared features with other “dry-mouth”-related caries.Braz Dent J. 2015; 26: 435-440
- Dosimetric distribution to the teeth of patients with head and neck cancer who underwent radiotherapy.Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 120: 416-419
- IMRT delivers lower radiation doses to dental structures than 3DRT in head and neck cancer patients.Radiat Oncol. 2016; 11: 116
- Radiation therapy alters microhardness and microstructure of enamel and dentin of permanent human teeth.J Dent. 2014; 42: 986-992
- Radiotherapy effect on nano-mechanical properties and chemical composition of enamel and dentin.Arch Oral Biol. 2015; 60: 690-697
- The impact of head and neck radiotherapy on the dentine-enamel junction: a systematic review.Med Oral Patol Oral Cir Bucal. 2020; 25: e96-e105
- Two-year clinical performance of glass ionomer and resin composite restorations in xerostomic head- and neck-irradiated cancer patients.Clin Oral Investig. 2011; 15: 31-38
- The effect of radiotherapy on dental hard tissue—a systematic review.Clin Oral Investig. 2014; 18: 17-24
- Stress analysis of irradiated human tooth enamel using finite element methods.Comput Methods Biomech Biomed Eng. 2017; 20: 1533-1542
- Dental demineralization and caries in patients with head and neck cancer.Oral Oncol. 2015; 51: 824-831
- Pulp vitality in patients with intraoral and oropharyngeal malignant tumors undergoing radiation therapy assessed by pulse oximetry.J Endod. 2011; 37: 1197-2000
- Late effects of head and neck radiotherapy on pulp vitality assessed by pulse oximetry.J Endod. 2016; 42: 886-889
- Micromorphology of the dental pulp is highly preserved in cancer patients who have undergone head and neck radiotherapy.J Endod. 2014; 40: 1553-1559
- Postradiation matrix metalloproteinase-20 expression and its impact on dental micromorphology and radiation-related caries.Caries Res. 2017; 51: 216-224
- Head and neck radiotherapy does not increase gelatinase (metalloproteinase-2 and -9) expression or activity in teeth irradiated in vivo.Oral Surg Oral Med Oral Pathol Oral Radiol. 2017; 124: 175-182
- Structural analysis of enamel in teeth of head-and-neck cancer patients who underwent radiotherapy.Caries Res. 2017; 51: 119-128
- Symptom clusters in patients with head and neck cancer receiving concurrent chemoradiotherapy.Oral Oncol. 2013; 49: 360-366
- Changes in symptom clusters in head and neck cancer patients undergoing post-operative radiotherapy: a longitudinal study.Eur J Oncol Nurs. 2018; 35: 62-66
Gouvêa Vasconcellos AF, Palmier NR, Prado Ribeiro AC, et al. Impact of clustering oral symptoms in the pathogenesis of radiation caries: a systematic review [E-pub ahead of print]. Caries Res. doi: 10.1159/000504878. Accessed on May 12, 2020.
- Radiation-related damage to dentition.Lancet Oncol. 2006; 7: 326-335
- Dental caries following radiotherapy for head and neck cancer: a systematic review.Oral Oncol. 2020; 100: 104484
- Cracked tooth syndrome in irradiated patients with head and neck cancer.Oral Surg Oral Med Oral Pathol Oral Radiol. 2018; 126: 335-341.e2
- A review of the diagnosis and management of the cracked tooth.Dent Update. 2009; 36: 338-346
- Post-radiation dental index: development and reliability.Support Care Cancer. 2008; 16: 525-530
- Radiation-induced dental caries, prevention and treatment—a systematic review.Natl J Maxillofac Surg. 2015; 6: 160-166
- Oral assessment and management of the patient with head and neck cancer.Oral Maxillofac Surg Clin North Am. 2018; 30: 445-458
- Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer.Int J Radiat Oncol Biol Phys. 2001; 50: 695-704
- Sparing all salivary glands with IMRT for head and neck cancer: longitudinal study of patient-reported xerostomia and head-and-neck quality of life.Radiother Oncol. 2018; 126: 68-74
- Saliva substitutes for the treatment of radiation-induced xerostomia—a review.Support Care Cancer. 2009; 17: 1331-1343
- Oral and dental health in head and neck cancer patients.Cancer Treat Res. 2018; 174: 43-57
- Effect of fluoride application during radiotherapy on enamel demineralization.J Appl Oral Sci. 2018; 27: e20180044
- The role of fluoride and chlorhexidine in preserving hardness and mineralization of enamel and cementum after gamma irradiation.Radiat Environ Biophys. 2017; 56: 187-192
- Anticariogenic efficacy of a saliva biomimetic in head-and-neck cancer patients undergoing radiotherapy.Aust Dent J. 2019; 64: 47-54
- Effect of a resin-modified glass-ionomer with calcium on enamel demineralization inhibition: an in vitro study.Braz Oral Res. 2019; 33: e015
- Prevention of dentine caries using silver diamine fluoride application followed by Er:YAG laser irradiation: an in vitro study.Lasers Med Sci. 2014; 29: 1785-1791
- Remineralisation of enamel with silver diamine fluoride and sodium fluoride.Dent Mater. 2018; 34: e344-e352
- Evidence-based dentistry update on silver diamine fluoride.Dent Clin North Am. 2019; 63: 45-68
- Potassium iodide. The solution to silver diamine fluoride discoloration?.Adv Dent Oral Health. 2017; 5: 555655
- Using silver diamine fluoride to arrest dental caries: a new approach in the US.Dent Oral Biol. 2017; 2: 1105
- Restoration of teeth with more-viscous glass ionomer cements following radiation-induced caries.Int Dent J. 2002; 52: 445-448
- A clinical comparison of glass ionomer, resin-modified glass ionomer and resin composite restorations in the treatment of cervical caries in xerostomic head and neck radiation patients.Oper Dent. 2002; 27: 430-437
- Radiation-induced root surface caries restored with glass ionomer cement placed in conventional and ART cavity preparations: results at two years.Aust Dent J. 2005; 50: 186-190
- Radiotherapy does not impair dentin adhesive properties in head and neck cancer patients.Clin Oral Invest. 2014; 18: 1771-1778
- Thirteen-year randomized controlled clinical trial of a two-step self-etch adhesive in non-carious lesions.Dental Mater. 2015; 31: 308-314
- Prosthetic rehabilitation of head and neck cancer patients focusing on mandibular dentures in irradiated patients.Int J Prosthodont. 2013; 26: 557-562
- Dental management of patients who have undergone oral cancer therapy.Dent Clin North Am. 2018; 62: 131-142
- Osteoradionecrosis prevention myths.Int J Radiation Oncology Biol Phys. 2006; 64: 661-669
Article info
Publication history
Published online: May 19, 2020
Accepted:
April 8,
2020
Received in revised form:
March 2,
2020
Received:
October 23,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
