RESUMO
AIM: The aim of this article is to review the clinical and biological features underlying the development and progression of radiation caries. BACKGROUND: Although radiotherapy (RT) plays an important role in the management of patients with head and neck cancer (HNC), it is also associated with several undesired side effects such as radiation caries which is a common, yet serious, complication. To review the condition, the Pubmed database was searched using the keywords "radiotherapy," "radiation," "caries," "hyposalivation," "prevention" and "management". Only studies published in the English language were selected. Cross-referencing identified additionally relevant studies. REVIEW RESULTS: RT leads to alterations in the dentition, saliva, oral microflora, and diet of patients. Consequently, irradiated patients are at increased risk for the development of a rapid, rampant carious process known as radiation caries. Motivation of patients, adequate plaque control, stimulation of salivary flow, fluoride use, and nutritional orientation are essential to reduce the incidence of radiation caries and ultimately improve the quality of life for HNC patients. CONCLUSION: Radiation caries is an aggressive side effect of RT. Dentists play an important role in the prevention of the condition via comprehensive oral healthcare before, during, and after the active cancer therapy. CLINICAL SIGNIFICANCE: Dentists should understand the clinical and biological aspects underlying radiation caries to prevent the development of lesions and provide optimal treatment when needed.
Assuntos
Cárie Dentária/etiologia , Esmalte Dentário/efeitos da radiação , Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia/efeitos adversos , Salivação/efeitos da radiação , Dieta Cariogênica , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Boca/microbiologia , Boca/efeitos da radiação , Doses de RadiaçãoRESUMO
Clinical examination alone is not enough to establish the true extent of local involvement and regional metastases. It has been suggested that computed tomography (CT) may provide valuable information for pretreatment staging. The role of lymphoscintigraphic analysis has not been investigated extensively in oral and oropharyngeal carcinoma. Information about the age, gender, site, size of the tumor, lymph node status and the tomographic and lymphoscintigraphic data were analyzed in 48 patients diagnosed with oral and oropharyngeal squamous cell carcinoma. The sensitivity of the homolateral clinical examination and CT were 77% and 55%, respectively, and the contralateral results were 66% and 16%, respectively. The specificity of the homolateral exams was 71% and 76% for the clinical examination and CT, respectively, whereas that of the contralateral exams was 100% and 90%, respectively. Lymphoscintigraphy showed the drainage pathway of the (99m )Tc-Dextran 500 in 64.6% of the cases. Homolateral drainage was favored by the tumors staged T1 and T2 that were clinically negative for nodal metastases. Bilateral drainage was associated with tumors close to or involving the midline. Non-drainage was related to tumors larger than 3.5 cm, stages T3 and T4, and the clinical presence of cervical metastases. Clinical examination was more efficient than CT to identify lymph node metastases. Lymphatic drainage of the head and neck regions is complex, and lymphoscintigraphy can be useful in oral and oropharyngeal carcinomas in clinical stages I and II, but further studies are necessary to standardize the methodology.