Research progress on preventive measures of radiation‐related caries caused by radiotherapy for nasopharyngeal carcinoma
Li Yanyao1, Jiang Li2, Zou Ling1
1State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China; 2State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
Abstract：Nasopharyngeal carcinoma (NPC) is one of the most common head and neck malignant tumors. A series of oral complications caused by radiotherapy, such as xerostomia, oral mucositis, limitation of mouth opening and radiation‐related caries, have greatly affected the quality of life of patients with nasopharyngeal carcinoma after radiotherapy. In this study, related studies on the preventive measures of radiation‐related caries caused by radiotherapy for nasopharyngeal carcinoma in recent years were reviewed, aiming to provide some guidance and theoretical basis for reducing the incidence of radiation‐related caries and improving the quality of life of patients with nasopharyngeal carcinoma after radiotherapy.
Li Yanyao,Jiang Li,Zou Ling. Research progress on preventive measures of radiation‐related caries caused by radiotherapy for nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2022, 31(10): 939-943.
[1] Del Regato JA. Dental lesions observed after roentgen therapy in cancer of the buccal cavity, pharynx and larynx [J]. Am J Roentgenol.1949, 42: 404‐410. [2] Palmier NR, Ribeiro A, Fonsêca JM, et al.Radiation-related caries assessment through the International Caries Detection and Assessment System and the Post-Radiation Dental Index[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2017,124(6):542-547. DOI: 10.1016/j.oooo.2017.08.019. [3] Elting LS, Chang YC. Costs of oral complications of cancer therapies: estimates and a blueprint for future study[J]. J Natl Cancer Inst Monogr, 2019,2019(53)DOI: 10.1093/jncimonographs/lgz010. [4] Morais-Faria K, Menegussi G, Marta G, et al.Dosimetric distribution to the teeth of patients with head and neck cancer who underwent radiotherapy[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2015,120(3):416-419. DOI: 10.1016/j.oooo.2015.05.009. [5] Reed R, Xu C, Liu Y, et al.Radiotherapy effect on nano-mechanical properties and chemical composition of enamel and dentine[J]. Arch Oral Biol, 2015,60(5):690-697. DOI: 10.1016/j.archoralbio.2015.02.020. [6] Thiagarajan G, Vizcarra B, Bodapudi V, et al.Stress analysis of irradiated human tooth enamel using finite element methods[J]. Comput Methods Biomech Biomed Engin, 2017,20(14):1533-1542. DOI: 10.1080/10255842.2017.1383401. [7] de Pauli Paglioni M, Palmier NR, Prado-Ribeiro AC, et al. The impact of radiation caries in the quality of life of head and neck cancer patients[J]. Support Care Cancer, 2020,28(6):2977-2984. DOI: 10.1007/s00520-019-05171-8. [8] Kielbassa AM, Hinkelbein W, Hellwig E, et al.Radiation-related damage to dentition[J]. Lancet Oncol, 2006,7(4):326-335. DOI: 10.1016/S1470-2045(06)70658-1. [9] Hu YJ, Shao ZY, Wang Q, et al.Exploring the dynamic core microbiome of plaque microbiota during head-and-neck radiotherapy using pyrosequencing[J]. PLoS One, 2013,8(2):e56343. DOI: 10.1371/journal.pone.0056343. [10] Xu Y, Teng F, Huang S, et al.Changes of saliva microbiota in nasopharyngeal carcinoma patients under chemoradiation therapy[J]. Arch Oral Biol, 2014,59(2):176-186. DOI: 10.1016/j.archoralbio.2013.10.011. [11] Zhang J, Liu H, Liang X, et al.Investigation of salivary function and oral microbiota of radiation caries-free people with nasopharyngeal carcinoma[J]. PLoS One, 2015,10(4):e0123137. DOI: 10.1371/journal.pone.0123137. [12] Sohn HO, Park EY, Jung YS, et al.Effects of the professional oral care management program on patients with head and neck cancer after radiotherapy: a 12-month follow-up[J]. J Dent Sci, 2021,16(1):453-459. DOI: 10.1016/j.jds.2020.09.010. [13] Fellous M, Couillin P, Neauport-Sautes C, et al.Studies of human alloantigens on man-mouse hybrids: possible syntheny between HL-A and P systems[J]. Eur J Immunol, 1973,3(9):543-548. DOI: 10.1002/eji.1830030904. [14] Opydo-Szymaczek J, Ogińska M, Wyrwas B.Fluoride exposure and factors affecting dental caries in preschool children living in two areas with different natural levels of fluorides[J]. J Trace Elem Med Biol, 2021,65:126726. DOI: 10.1016/j.jtemb.2021.126726. [15] Lin J, Yao H.[Effects of pit and fissure sealant combined with fluorine protective paint on prevention of children caries aged 5-8 years old][J]. Shanghai Kou Qiang Yi Xue, 2019,28(4):384-387. [16] Soutome S, Yanamoto S, Murata M, et al.Evaluation of the efficacy of low concentration fluoride gel using custom trays to prevent radiation-related dental caries in patients with head and neck cancer: protocol for a randomised controlled phase III trial (FluCar study)[J]. BMJ Open, 2020,10(9):e038606. DOI: 10.1136/bmjopen-2020-038606. [17] Yu OY, Mei ML, Zhao IS, et al.Remineralisation of enamel with silver diamine fluoride and sodium fluoride[J]. Dent Mater, 2018,34(12):e344-e352. DOI: 10.1016/j.dental.2018.10.007. [18] Crystal YO, Niederman R.Evidence-based dentistry update on silver diamine fluoride[J]. Dent Clin North Am, 2019,63(1):45-68. DOI: 10.1016/j.cden.2018.08.011. [19] O'Mullane DM, Baez RJ, Jones S, et al. Fluoride and oral health[J]. Community Dent Health, 2016,33(2):69-99. [20] Mathias J, Kavitha S, Mahalaxmi S.A comparison of surface roughness after micro abrasion of enamel with and without using CPP-ACP: an in vitro study[J]. J Conserv Dent, 2009,12(1):22-25. DOI: 10.4103/0972-0707.53337. [21] Morgan MV, Adams GG, Bailey DL, et al.The anticariogenic effect of sugar-free gum containing CPP-ACP nanocomplexes on approximal caries determined using digital bitewing radiography[J]. Caries Res, 2008,42(3):171-184. DOI: 10.1159/000128561. [22] Sim CP, Wee J, Xu Y, et al.Anti-caries effect of CPP-ACP in irradiated nasopharyngeal carcinoma patients[J]. Clin Oral Investig, 2015,19(5):1005-1011. DOI: 10.1007/s00784-014-1318-y. [23] Sim C, Walker GD, Manton DJ, et al.Anticariogenic efficacy of a saliva biomimetic in head-and-neck cancer patients undergoing radiotherapy[J]. Aust Dent J, 2019,64(1):47-54. DOI: 10.1111/adj.12658. [24] Abdalla R, Niazy MA, Jamil WE, et al.The role of fluoride and chlorhexidine in preserving hardness and mineralization of enamel and cementum after gamma irradiation[J]. Radiat Environ Biophys, 2017,56(2):187-192. DOI: 10.1007/s00411-017-0690-9. [25] Li Y, Jiang X, Hao J, et al.Tea polyphenols: application in the control of oral microorganism infectious diseases[J]. Arch Oral Biol, 2019,102:74-82. DOI: 10.1016/j.archoralbio.2019.03.027. [26] 迟惠文, 陶文韬, 王子璇, 等. 中药防龋的研究进展[J].中国中医药现代远程教育,2019,17(9):131-134. DOI: 10.3969/j.issn.1672-2779.2019.09.052. Chi HW, Tao WT, Wang ZX, et al.The research progress on Chinese medicine in preventing dental caries[J].Chinese Medicine Modern Distance Education of China,2019,17(9):131-134. DOI: 10.3969/j.issn.1672-2779.2019.09.052. [27] Pereira IF, Firmino RT, Meira HC, et al.Radiation-induced oral mucositis in Brazilian patients: prevalence and associated factors[J]. In Vivo, 2019,33(2):605-609. DOI: 10.21873/invivo.11517. [28] Brennan MT, Treister NS, Sollecito TP, et al.Dental disease before radiotherapy in patients with head and neck cancer: clinical registry of dental outcomes in head and neck cancer patients[J]. J Am Dent Assoc, 2017,148(12):868-877. DOI: 10.1016/j.adaj.2017.09.011. [29] Ala M, Mohammad Jafari R, Ala M, et al.Sumatriptan alleviates radiation-induced oral mucositis in rats by inhibition of NF-kB and ERK activation, prevention of TNF-α and ROS release[J]. Arch Oral Biol, 2020,119:104919. DOI: 10.1016/j.archoralbio.2020.104919. [30] de Carvalho P, Lessa RC, Carraro DM, et al. Three photobiomodulation protocols in the prevention/treatment of radiotherapy-induced oral mucositis[J]. Photodiagnosis Photodyn Ther, 2020,31:101906. DOI: 10.1016/j.pdpdt.2020.101906. [31] Peng J, Shi Y, Wang J, et al. Low-level laser therapy in the prevention and treatment of oral mucositis: a systematic review and meta-analysis[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2020,130(4):387-397.e9. DOI: 10.1016/j.oooo.2020. 05.014. [32] Khanal B, Baliga M, Uppal N.Effect of topical honey on limitation of radiation-induced oral mucositis: an intervention study[J]. Int J Oral Maxillofac Surg, 2010,39(12):1181-1185. DOI: 10.1016/j.ijom.2010.05.014. [33] Tian X, Xu L, Liu Xet al. Impact of honey on radiotherapy‐induced oral mucositis in patients with headLiu X Impact of honey on radiotherapy‐induced oral mucositis in patients with head and neck cancer: a systematic review and meta‐analysis [J]. Ann Palliat Med, 2020,9(4): 1431‐1441. DOI: 10.21037/apm‐20‐44. [34] Bakr IS, Zaki AM, El-Moslemany RM, et al.Vitamin D oral gel for prevention of radiation-induced oral mucositis: a randomized clinical trial[J]. Oral Dis, 2021,27(5):1197-1204. DOI: 10.1111/odi.13650. [35] Shu Z, Zeng Z, Yu B, et al.Nutritional status and its association with radiation-induced oral mucositis in patients with nasopharyngeal carcinoma during radiotherapy: a prospective study[J]. Front Oncol, 2020,10:594687. DOI: 10.3389/fonc.2020.594687. [36] Bhatia KS, King AD, Paunipagar BK, et al.MRI findings in patients with severe trismus following radiotherapy for nasopharyngeal carcinoma[J]. Eur Radiol, 2009,19(11):2586-2593. DOI: 10.1007/s00330-009-1445-z. [37] Wu VW, Lam YN.Radiation-induced temporo-mandibular joint disorder in post-radiotherapy nasopharyngeal carcinoma patients: assessment and treatment[J]. J Med Radiat Sci, 2016,63(2):124-132. DOI: 10.1002/jmrs.145. [38] Sim C, Soong YL, Pang E, et al.Xerostomia, salivary characteristics and gland volumes following intensity- modulated radiotherapy for nasopharyngeal carcinoma: a two- year follow up[J]. Aust Dent J, 2018,63(2):217-223. DOI: 10.1111/adj.12608. [39] Almståhl A, Wikström M, Fagerberg-Mohlin B.Microflora in oral ecosystems and salivary secretion rates--a 3-year follow-up after radiation therapy to the head and neck region[J]. Arch Oral Biol, 2015,60(9):1187-1195. DOI: 10.1016/j.archoralbio.2015.04.004. [40] Marimuthu D, Han KM, Mohamad M, et al.Saliva substitute mouthwash in nasopharyngeal cancer survivors with xerostomia: a randomized controlled trial[J]. Clin Oral Investig, 2021,25(5):3105-3115. DOI: 10.1007/s00784-020-03634-5. [41] Snider JW, Paine CC.Sticky stuff: xerostomia in patients undergoing head and neck radiotherapy-prevalence, prevention, and palliative care[J]. Ann Palliat Med, 2020,9(3):1340-1350. DOI: 10.21037/apm.2020.02.36. [42] Riley P, Glenny AM, Hua F, et al. Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy[J]. Cochrane Database Syst Rev, 2017,7(7):CD012744. DOI: 10.1002/14651858.CD012744. [43] Ramos-Casals M, Brito-Zerón P, Bombardieri S, et al.EULAR recommendations for the management of Sjögren's syndrome with topical and systemic therapies[J]. Ann Rheum Dis, 2020,79(1):3-18. DOI: 10.1136/annrheumdis-2019-216114. [44] Poon D, Kam M, Johnson D, et al.Durability of the parotid-sparing effect of intensity-modulated radiotherapy (IMRT) in early stage nasopharyngeal carcinoma: a 15-year follow-up of a randomized prospective study of IMRT versus two-dimensional radiotherapy[J]. Head Neck, 2021,43(6):1711-1720. DOI: 10.1002/hed.26634. [45] Wang K, Li S, Liu J, et al. [Dosimetry and salivary gland protection of spiral tomotherapy and conventional intensity modulated radiotherapy for pharyngeal carcinoma][J]. J Ch Oncol, 2019,25(2):166‐168. DOI: 10.11735/j. issn. 1671‐170X. 2019.02.B01. [46] Teng F, Fan W, Luo Y, et al.Reducing xerostomia by comprehensive protection of salivary glands in intensity- modulated radiation therapy with helical tomotherapy technique for head-and-neck cancer patients: a prospective observational study[J]. Biomed Res Int, 2019,2019:2401743. DOI: 10.1155/2019/2401743. [47] Liang X, Zhang J, Peng G, et al.Radiation caries in nasopharyngeal carcinoma patients after intensity-modulated radiation therapy: a cross-sectional study[J]. J Dent Sci, 2016,11(1):1-7. DOI: 10.1016/j.jds.2015.09.003. [48] Kaanders JH, Fleming TJ, Ang KK, et al.Devices valuable in head and neck radiotherapy[J]. Int J Radiat Oncol Biol Phys, 1992,23(3):639-645. DOI: 10.1016/0360-3016(92)90023-b. [49] Verrone JR, Alves Fde A, Prado JD, et al.Impact of intraoral stent on the side effects of radiotherapy for oral cancer[J]. Head Neck, 2013,35(7):E213-217. DOI: 10.1002/hed.23028. [50] Chen D, Chen X, Chen X, et al.The efficacy of positioning stents in preventing Oral complications after head and neck radiotherapy: a systematic literature review[J]. Radiat Oncol, 2020,15(1):90. DOI: 10.1186/s13014-020-01536-0.
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