Over 300 Radiation Caries Papers: Reflections From the Rearview Mirror

Abstract

Radiation caries (RC) is an aggressive oral toxicity in head and neck cancer survivors, which develops 6 to 12 months after head and neck radiotherapy. It initially affects the tooth cervical/incisal surfaces, and if not promptly diagnosed/managed, progresses to dental crown amputation and risk of osteoradionecrosis. It results from a multidimensional cluster of treatment-induced oral symptoms, including hyposalivation, dietary changes, and oral hygiene impairment. Although recognized as a frequent complication of radiotherapy and extensively assessed by a myriad of retrospective, in vitro, and in situ studies, RC patients are still orphans of clinically validated methods for risk prediction, prevention, and treatment of early lesions. This review provides a historical overview of science-based concepts regarding RC pathogenesis and treatment, emphasizing the growing demand for interventional clinical studies (randomized trials).

Keywords: dental caries; dental demineralization; head and neck cancer; radiation; radiation caries; radiotherapy.

Figure 1

Flowchart describing literature searches.

Figure 2

Radiation caries clinical stages. (A,B) Representation of incipient radiation caries with presence of superficial enamel changes with brownish pigmentation on the smooth surfaces. (C) Demineralization and delamination enamel spots representing the second stage. (D) Crown amputation is the last stage of radiation caries with progressively faster pattern.