Radiation-related damage to dentition

Radiation-related damage to dentition
Andrej M Kielbassa, Wolfgang Hinkelbein, Elmar Hellwig, Hendrik Meyer-Lückel
Because of typical tissue reactions to ionising radiation, radiotherapy in the head and neck region usually results in complex oral complications aff ecting the salivary glands, oral mucosa, bone, masticatory musculature, and dentition. When the oral cavity and salivary glands are exposed to high doses of radiation, clinical consequences including hyposalivation, mucositis, taste loss, trismus, and osteoradionecrosis should be regarded as the most common side-eff ects. Mucositis and taste loss are reversible consequences, usually subsiding early post-irradiation, whereas hyposalivation is commonly irreversible. Additionally, the risk of rampant tooth decay with its sudden onset and osteonecrosis is a lifelong threat. Thus, early, active participation of the dental profession in the development of preventive and therapeutic strategies, and in the education and rehabilitation of patients is paramount in consideration of quality-of-life issues during and after radiotherapy. This Review focuses on the multifactorial causes of so-called radiation caries and presents possible treatment strategies to avoid loss of dentition. Introduction
Depending on the location of a malignant disease
(primary tumour, lymph-node metastases), inevitably, the salivary glands, oral mucosa, and jaws have to be included in the radiotherapy portals. In addition to the undisputed anticancer eff ects of ionising irradiation, it will cause damage in healthy tissues located in the fi eld of radiation. This eff ect becomes especially evident in the head and neck region, where several dissimilar structures (skin, mucosa, subcutaneous connective tissue, salivary gland tissue, teeth, and bone) are located.
These tissues usually show diff erent reactions to radiotherapy, which vary from acute or transient changes (mucosa, taste, salivary glands) to intermediate