RESUMO
BACKGROUND: This study aimed to investigate the morphology and chemical composition of dental caries related to ionizing radiation (DCIR), an aggressive and progressive disease that affects dental hard tissues. MATERIALS AND METHODS: Eight human teeth with DCIR were paired with sixteen control teeth (8 teeth with conventional caries and 8 without caries) and included in this study. An analysis of the morphology of the lesions was performed using the following techniques: periapical radiography, cone beam computed tomography, computed microtomography, and scanning electron microscopy. The chemical composition was assessed using X-ray dispersive spectroscopy. RESULTS: There was more demineralization in DCIR lesions when compared to conventional dental caries, even though there was no cavitation in the cervical region of the teeth. The superficial roughness and topography of DCIR lesions were similar to those of healthy teeth. On the other hand, lesions of conventional dental caries showed greater surface and topographic irregularity when compared to DCIR and healthy teeth (p = 0.001). Calcium (Ca) and phosphorus (P) levels were lower in DCIR lesions when compared to controls. However, higher levels of carbon (C) have been observed in DCIR lesions. There was a greater loss of the mineral matrix in DCIR followed by conventional caries. The reduction in the mineral matrix (Ca and P) was compatible with the imaging patterns observed in teeth with DCIR and conventional caries. CONCLUSION: Despite their rapid evolution, DCIR presents an irregular, apparently intact surface with significant changes in the amount of Ca, P, and C.
RESUMO
PURPOSE: Osteoradionecrosis is a complication of head and neck radiotherapy, with a difficult resolution and no well-established treatment. The disease progression can cause important loss on patient's quality of life after cancer treatment. The options for treatment are limited and include clinical monitoring, prescription, or surgical procedures. As an alternative for bone necrosis treatment, a combination of drugs, pentoxifylline and tocopherol, can be used. Studies have shown that this combination significantly reduces chronic radiotherapy damage. The article reports successful treatment with this prescription protocol. METHODS: We report three cases of patients referred to the Service of Oral and Maxillofacial Surgery at Erasto Gaertner Hospital, in Curitiba, Brazil. They were submitted to radiotherapy for the treatment of malignant head and neck tumors and later developed osteoradionecrosis. They were treated with the combination pentoxifylline and tocopherol. RESULTS: All patients achieved complete remission in less than 1 year, with complete healing of bone exposure and without clinical symptoms. CONCLUSIONS: This results show that this combination of drugs is beneficial in cases of bone necrosis induced by radiation, avoiding more aggressive treatments and reducing morbidity.