Modern aspects of the negative impact of remote ɣ-therapy for malignant neoplasms of the maxillofacial region on the formation of pathological processes in teeth

This systematic review presents data from literature sources on the development of pathological processes in teeth following radiotherapy for malignant neoplasms (MN) of the maxillofacial region (MFR). Materials from E-LIBRARY, PubMed, Google Scholar, and Elsevier Science Direct were used for analysis and evaluation. The sample consists of scientific papers devoted to the effects of ionizing radiation on the condition of teeth after radiation treatment for malignant neoplasms of the maxillofacial region. The generalized results of clinical and experimental studies presented in this review demonstrate the specific influence of remote radiotherapy for MN of the MFR on the characteristics of dental pathology manifestation, both in the short and long term after treatment completion, characterized by intensive tooth decay. Remote radiotherapy, being the main method of treatment for MN of the MFR, contributes to the occurrence of morphological changes in dental tissues. Changes in hard tissues and dental pulp are directly related to radiotherapy for MN of the MFR. However, there is currently no consensus among specialists regarding the pathogenetic mechanisms of radiation-induced destruction of dental tissues and pulp. Some authors characterize these post-radiation changes in the oral cavity as acute multiple caries, while others attribute this pathological process to non-carious lesions that develop after tooth eruption. Furthermore, patients with MN exhibit different patterns of hard dental tissue damage depending on the location of radiation exposure. After radiation treatment in the head and neck region, enamel and dentin necrosis complicated by caries and acute rapidly progressing caries are observed, while after radiation treatment in the chest and pelvic organs, acute and hyperacute caries are observed, and in some clinical cases, cervical enamel necrosis. In this regard, the problem of studying the pathogenesis of radiation-induced tooth damage is relevant for improving the effectiveness of rehabilitation of cancer patients and developing tactics for complex medical and social rehabilitation. The problem of dental condition after remote ɣ-therapy for MN of the MFR remains understudied and requires further research to determine the tactics of dispensary observation and the specifics of applied therapeutic, preventive, and rehabilitative dental measures.

1. Amadyan M.G., Shagoyan A.G., Khachkavantsyan A.S. The use of antioxidants in the treatment of radiation injuries. Journal of Experimental and Clinical Medicine. 1989;29(1):53–57 (in Russian).

2. Bardychev M.S., Tsyb A.F. Local radiation injuries: A guide for physicians. Moscow: Medicine. 1985;240 (in Russian).

3. Barer G.M., Komnova Z.D. Morphological changes in the pulp, dentin, and cementum of irradiated “intact” teeth. Stomatology. 1984;63(3):28–30 (in Russian).

4. Barer G.M., Komnova Z.D. Pathological changes in the pulp and dentin of teeth in experimental animals under the influence of radiant energy. Stomatology. 1985;64(4):8–11 (in Russian).

5. Barer G.M., Nazarov G.I. Tooth damage after radiation therapy for malignant tumors of the maxillofacial region. Stomatology. 1965;6:23–26 (in Russian).

6. Borovsky E.V., Sazonov N.I., Lebedeva G.K. The effect of remote gamma irradiation on the hard tissues of teeth. Stomatology. 1976;2:1–4 (in Russian).

7. Borovsky E.V., Segen I.T. The state of hard dental tissues depending on the dose and localization of irradiation. Stomatology. 1973;2:16–18 (in Russian).

8. Vazhenin A.V. Radiation oncology: Organization, tactics, development paths. Moscow: RAMS. 2003:236 (in Russian).

9. Vtyurin B.M., Bardychev M.S., Galontseva G.F., et al. Clinical presentation, diagnosis, prevention, and treatment of radiation injuries of the oral cavity. Methodological recommendations. Obninsk. 1983:18 (in Russian).

10. Dmitrieva E.F., Nurieva N.S. The effect of radiation therapy on hard dental tissues in patients with oropharyngeal cancer. Dental Magazin. 2017;1(157):38–40 (in Russian).

11. Dmitriev E.F., Nurieva N.S. Radiation caries: Clinical picture, treatment issues. Problems of Stomatology. 2014;2:9–12 (in Russian).

12. Zavyalova V.A., Ivanchikova L.A. Ultrastructure of pulp capillaries in rabbits after local fractional gamma irradiation of the mandible. Stomatology. 1975;54(3):74–79 (in Russian).

13. Zyryanov G.V., Apollonova L.A., Bogomazov M.Y., et al. Features of the development of experimental apical periodontitis against the background of immunodeficiency caused by irradiation. Stomatology. 1992;(2):13– 15 (in Russian).

14. Ivanova L.A. Prevention of post-radiation dental lesions (Methodological recommendations). Perm. 1987;11 (in Russian).

15. Nazarov G.I. Changes in teeth and jaws after local gamma irradiation. Medical Radiology. 1975;8:75–76 (in Russian).

16. Inzhina E.V., Kochurova E.V., Seferyan K.G. The influence of antitumor treatment on the dental status of patients with malignant neoplasms of the oropharyngeal zone. Kuban Scientific Medical Bulletin. 2017;24(5):111– 119 (in Russian). https://doi.org/10.25207/1608-6228-2017-24-5-111-119.

17. Nazarov G.I., Nikitenko V.A. Radiation changes in hard dental tissues against the background of their functional overload. Stomatology. 1976;1:5-7 (in Russian).

18. Nurieva N.S., Filimonova O.I. Radiation lesions of teeth. Tactics of the dentist. Medical Science and Education of the Urals. 2011;12(1(65)):184-185 (in Russian).

19. Obukhov Y.A., Zhukovskaya E.V., Karelin A.F. Radiation caries in patients receiving therapy for neoplasms: Literature review and own clinical observations. Russian Journal of Pediatric Hematology and Oncology. 2018;5(4):40–50 (in Russian). https://doi.org/10.17650/2311-1267-2018-5-4-40-50.

20. Paches A.I., Olshansky V.O., Lyubaev V.L., et al. Malignant tumors of the oral cavity, pharynx, and larynx. Moscow: Medicine. 1988;302 (in Russian).

21. Prokhonchukov A.A. Changes in mineral metabolism in hard dental tissues in chronic radiation sickness. Medical Radiology. 1960;11:41–45 (in Russian).

22. Prokhonchukov A.A., Panikarovsky, V.V. Morphological changes in the dentoalveolar system after prolonged exposure to low doses of x-rays. Stomatology. 1969;2:38–41 (in Russian).

23. Tarusov B.N. Primary processes of radiation damage. Moscow: Gosatomizdat. 1962;96 (in Russian).

24. Tsyb A.F., Mardinsky, Yu.S. (Eds.). Therapeutic radiology. Guide for physicians. Moscow: OOO “MK”. 2010;552 (in Russian).

25. Fedyaev I.M., Bayrikov I.M., Belova L.P., et al. Malignant tumors of the maxillofacial region. Moscow: Medicine. Nizhny Novgorod: NGMA Publishing House. 2000;160.

26. Chestnykh E.V., Goreva L.A., Sokolova K.S., et al. Radiation caries and radiomucositis as complications of radiation therapy: clinical presentation, treatment, prevention (literature review). Verkhnevolzhsky Medical Journal. 2020;19(2):21–26 (in Russian).

27. Chochia K.N., Shimanovskaya K.B. Tooth damage and necrosis of the mandible as complications of radiation treatment for oral cancer. Bulletin of Roentgenology and Radiology. 1958;3:32–37 (in Russian).

28. Alfouzan A.F. Radiation therapy in head and neck cancer: Saudi Med J. 2021;42(3):247–254. https://doi.org/10.15537/smj.2021.42.3.20210660.

29. Brennan M.T., Treister N.S., Sollecito T.P., et al. Dental caries postradiotherapy in head and neck cancer: JDR Clin. Trans. Res. 2023;8(3):234–243. https://doi.org/10.1177/23800844221086563.

30. Faria K.M., Brandão T.B., Ribeiro A.C. P. et al. Micromorphology of the dental pulp is highly preserved in cancer patients who underwent head and neck radiotherapy: J. Endod. 2014;40(10):1553–9. https://doi.org/10.1016/j.joen.2014.07.006.

31. Fonsêca J., Palmier N., Silva W., et al. Dentin-pulp complex reactions in conventional and radiationrelated caries: A comparative study. J. Clin. Exp. Dent. 2019;11(3):236–243. https://doi.org/10.4317/jced.55370.

32. Galvão-Moreira L.V., Cruz M.C.F.N. Dental demineralization, radiation caries and oral microbiota in patients with head and neck cancer: Oral Oncol. 2015; 51(12):89-90. https://doi.org/10.1016/j.oraloncology.2015.10.008.

33. Gomes-Silva W., Morais-Faria K., Rivera C., et al. Impact of radiation on tooth loss in patients with head and neck cancer: a retrospective dosimetric-based study: Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. 2021;132(4):409–417. https://doi.org/10.1016/j.oooo.2021.06.021.

34. Gonçalves L.M.N., Palma-Dibb R. G., Paula-Silva F. W. G., et al. Radiation therapy alters microhardness and microstructure of enamel and dentin of permanent human teeth: J. Dent. 2014;42(8):986–92. https://doi.org/10.1016/j.jdent.2014.05.011.

35. Kataoka S., Setzer F., Gondim-Junior E., et al. Late effects of head and neck radiotherapy on pulp vitality assessed by pulse oximetry: J. Endod. 2016;42(6)886–9. https://doi.org/10.1016/j.joen.2016.02.016.

36. Kielbassa A.M., Hinkelbein W., Hellwig E., Meyer-Lückel H. Radiation-related damage to dentition: Lancet Oncol. 2006;7(4):326-35. https://doi.org/10.1016/S1470-2045(06)70658-1.

37. Lopez J., Tufaro A.P. Malignant maxillofacial bone tumors: Curr. Opin. Otolaryngol. Head Neck Surg. 2019;27(4):294-301. https://doi.org/10.1097/MOO.0000000000000555.

38. Madrid C.C., Paglioni, M.P. Line S.R., et al. Structural analysis of enamel in teeth from head-and-neck cancer patients who underwent radiotherapy: Caries Res. 2017;51(2):119–128. https://doi.org/10.1159/000452866.

39. Palmier N.R., Prado-Ribeiro A.C., Mariz B. A. L. A., et al. The impact of radiation caries on morbidity and mortality outcomes of head and neck squamous cell carcinoma patients: Spec. Care Dentist. 2024;44(1):184–195. https://doi.org/10.1111/scd.12843.

40. Palmier N.R., Migliorati C.A., Prado-Ribeiro A.C. et al. Radiation-related caries: current diagnostic, prognostic, and management paradigms: Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. 2020;130(1):52–62. https://doi.org/10.1016/j.oooo.2020.04.003.

41. Pedroso C.M., Migliorati C.A., Epstein J.B., et al. Over 300 radiation caries papers: reflections from the rearview mirror: Front Oral Health. 2022;14(3):961594. https://doi.org/10.3389/froh.2022.961594.

42. Rahman S., Maillou P., Barker D., et al. Radiotherapy and the oral environment the effects of radiotherapy on the hard and soft tissues of the mouth and its management: Eur. J. Prosthodont. Restor. Dent. 2013;21(2):80–7.

43. Reed R., Xu C., Liu Y., et al. Radiotherapy effect on nano-mechanical properties and chemical composition of enamel and dentine: Arch. Oral. Biol. 2015;60(5):690–7. https://doi.org/10.1016/j.archoralbio.2015.02.020.

44. Sonis S. A biological approach to mucositis: J. Support. Oncol. 2004;2(1):21–32.

45. Sonis S. Mucositis as a biological process: a new hypothesis for the development of chemytherapyindyced stomatoxicity: Oral. Oncology. 19984;34(1):34–39.

46. Suri S., Raura N., Thomaset M.S., et al. Change in surface characteris-tics and permeability of human enamel after subjecting to radiation therapy: Niger J. Clin Pract. 2022;25(10):1687–1692. https://doi.org/10.4103/njcp.njcp_151_22.

47. Vissink A., Jansma J., Spijkervet F.K.L., et al. Oral sequelae of head and neck radiotherapy: Crit. Rev. Oral. Biol. Med. 2003;14(3):199–212. https://doi.org/1177/154411130301400305.

48. Weissheimer T., Só B.B., Pradebon M.C., et al. Head and neck radio-therapy effects on the dental pulp vitality and response to sensitivity tests: A systematic review with meta-analysis: Int. Endod J. 2022;55(6):563– 578. https://doi.org/10.1111/iej.13726.