Abstract
Simple SummaryOur research suggest radioiodine-131 used for differentiated thyroid carcinomas has an impact on the oral health of patients. We found that alteration of dental hard tissues starts after 6 h post-radioiodine administration. These findings highlight the importance of the multidisciplinary team management in the quality of life of the oncological patient.Radioiodine-131 (I-131) is an essential therapy for patients with differentiated thyroid carcinomas (DTC). Generally, I-131 is safe and well tolerated, but patients may present early or late complications in the oral and maxillofacial areas. Thus, the aim of this study was to evaluate in-vitro, the alteration of enamel and dentin after I-131 exposure using histopathological assessment, scanning electron microscopy (SEM) and atomic force microscopy (AFM). For I-131 irradiation, an in-vitro protocol was used that simulates the procedure for irradiation therapy performed for patients with DTCs. A total of 42 teeth were divided into seven groups (n = 6) and irradiated as follows: control, irradiation groups (3, 6, 12, 36, 48 h, 8 days). Histological changes were observed at 48 h (enamel surface with multifocal and irregular areas) and at 8 days (enamel surface with multiple, very deep, delimited cavities). SEM imaging revealed the enamel destruction progresses along with the treatment time increasing. The alterations are extended into the enamel depth and the dislocated hydroxyapatite debris is overwhelming. The enamel-dentine interface shows small gaps after 6 h and a very well developed valley after 12 h; the interface microstructure resulted after 8 days is deeply altered. The AFM imaging shows that I-131 affects the protein bond between hydroxyapatite nano-crystals causing loss of cohesion, which leads to significant increasing of nano-particles diameter after 6 h. In conclusion, both enamel and dentin appear to be altered between 12 and 48 h and after 8 days of treatment are extended in depth.
Highlights
Radioiodine-131 (I-131) therapy has been used for decades in treating hyperthyroidism, Grave’s disease and well differentiated thyroid malign pathologies [1,2,3]; due to increasing incidence of the thyroid cancer, the use of I-131 is significantly higher in the last years [4]. radioiodine is widely used for its therapeutic effects and in general well accepted by the human organism, several late side effects have been described over the years
All specimens were washed with water, if necessary, dental calculus was removed with ultrasonic scaling, immersed in ultrasonic bath, dried and examined on microscope (10× magnification); at the end of this protocol, specimens were immersed in artificial saliva (4 °C; 1 month)
No histological changes in the enamel structure and morphology were identified in the control group
Summary
Radioiodine is widely used for its therapeutic effects and in general well accepted by the human organism, several late side effects have been described over the years These side effects can occur because of the external action of the radiation or can be linked to the immune system of the patient or to the function of the thyroid gland [4]. Salivary duct stenosis can play an important role in the appearance of obstructive sialadenitis symptoms [8] For this reason, one of the constant met repercussion is xerostomia [9], manifested trough dry mouth complains of the irradiated patients. The occurrence and the precedency of Sjogren Syndrome should be evaluated, before initiation of radioactive iodine therapy [10] All these manifestations are often accompanied by deterioration of the taste capacity, trough hypogeusia or dysgeusia [11]
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