Dentin-pulp complex reactions in conventional and radiation-related caries: A comparative study.

Jm Fonseca,Nr Palmier,Tb Brandao,Km Faria,Ma Lopes,Wg Silva,Acp Ribeiro,Jv Salvajoli,Pa Vargas

doi:10.4317/jced.55370

Abstract

BackgroundRadiation-related caries (RRC) is one of the most significant oral toxicities of head and neck radiotherapy (HNRT); however, the potential of radiation to directly cause harmful dentin and pulpal effects and impair response to caries progression is controversial.Material and MethodsTherefore, the aim of this study was to characterize the reactions of the dentin-pulp complex in teeth affected by RRC. Patients and methods: Twenty-two carious teeth extracted from 22 head and neck cancer (HNC) patients were divided into control (conventional caries; n=11) and irradiated (RRC; n=11) groups and paired matched by dental homology, clinical patterns of caries progression following the Post-Radiation Dental Index (PRDI) and microscopic depth of carious invasion. Histopathological characteristics based on morphological hierarchy, cell populations of dental pulp, blood vessels, neural elements, extracellular matrix components, inflammation, patterns of carious invasion and reactionary dentin presence were evaluated by optical light microscopy and histomorphometry.ResultsMean PRDI scores were 3.2 for the control group and 3.8 for the irradiated group. Dentin demineralization patterns were also similar between the groups and the mean depths of demineralization were 1,158.58µm and 1,056.89µm for the control and irradiated groups, respectively.ConclusionsPulp histopathological changes and dentin reaction patterns were similar between groups and varied according to the PRDI scores and carious lesions depth. Dentin and pulp reactions are highly preserved in RRC teeth. Key words:Cancer, radiotherapy, radiation-related caries, teeth, pulp.

Highlights

Head and neck cancer (HNC) represent 6% of all human malignancies and approximately 650,000 new cases are annually diagnosed worldwide
This study aimed to test the hypothesis that the in vivo irradiated human teeth affected by Radiation-related caries (RRC) have microscopically discernible effect on dentin and pulp responses when compared to conventional caries teeth samples, such as changes in the morphological pulp hierarchy, alteration in the blood vessels structure, pulp fibrosis, high incidence of calcification and necrosis and atypical pulp inflammation patterns
The potential of head and neck radiotherapy (HNRT) to cause direct harmful dentin and pulpal effects that could impair the response of the dentin-pulp complex to caries progression is controversial

Summary

Introduction

Head and neck cancer (HNC) represent 6% of all human malignancies and approximately 650,000 new cases are annually diagnosed worldwide. Some studies have suggested that this direct radiogenic damage to structural components of the dentin and pulp, would lead to RRC [5,6], others have linked the increased risk of caries in post-HNRT patients with the indirect effects of radiotherapy (RT). Patients and methods: Twenty-two carious teeth extracted from 22 head and neck cancer (HNC) patients were divided into control (conventional caries; n=11) and irradiated (RRC; n=11) groups and paired matched by dental homology, clinical patterns of caries progression following the Post-Radiation Dental Index (PRDI) and microscopic depth of carious invasion. Dentin and pulp reactions are highly preserved in RRC teeth

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Conclusion