Supportive Care in Cancer

, 18:83 | Cite as

Radiation-related caries and early restoration failure in head and neck cancer patients. A polarized light microscopy and scanning electron microscopy study

  • Alan Roger S. Silva
  • Fabio A. Alves
  • Sandrine B. Berger
  • Marcelo Giannini
  • Mario F. Goes
  • Marcio A. LopesEmail author
Original Article



Radiation-related caries is a disease with high potential of teeth destruction in patients who have undergone radiotherapy in the head and neck region. Also, it is a challenge for dentistry due to high rates of recurrent caries and early restorations failure.


This study aims to analyze the early restoration failures in order to better understand the etiology of dental restorations reduced longevity in irradiated teeth.


Fifteen restored permanent teeth extracted from 11 patients who had finished head and neck radiotherapy were studied. Sections from each tooth were prepared and a qualitative description of the interface between restorations and dentin was performed by using polarized light microscopy and scanning electron microscopy.


Unfavorable anatomical shape of restorations, residual caries, and secondary caries affecting dentin adjacent to restorative materials were widely found. The morphological patterns of these carious lesions were similar to conventional dentin lesions with superficial demineralized zone and translucent zone.


Early dental restoration failure in teeth affected by radiation-related caries may have the same etiological factors from ordinary dental restoration failure and direct radiogenic damage to dentition would not be essential to early restorations failure in radiation-related caries.


Radiation caries Radiation-related caries Radiotherapy Polarized light microscopy Scanning electron microscopy 



This investigation was supported by National Council for Scientific and Technological Development (CNPq), Brazil—Process: 131654/2006-3. The authors would like to thank Dr. Alberto Antunes from the Dental Materials Section, Piracicaba Dental School, for his assistance during the specimen’s preparation and Adriano Luis Martins from the Oral Pathology Section, Piracicaba Dental School, for his assistance during SEM examination.


  1. 1.
    Silva ARS, Alves FA, Antunes A, Goes MF, Lopes MA (2009) Patterns of demineralization and dentin reactions in radiation-related caries. Caries Res 43:43–49. doi: 10.1159/000192799 CrossRefPubMedGoogle Scholar
  2. 2.
    Vissink A, Jansma J, Spijkervet FK, Burlage FR, Coppes RP (2003) Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 14:199–212. doi: 10.1177/154411130301400305 CrossRefPubMedGoogle Scholar
  3. 3.
    Kielbassa AM, Hinkelbein W, Hellwig E, Meyer-Lückel H (2006) Radiation-related damage to dentition. Lancet Oncol 7:326–335. doi: 10.1016/S1470-2045(06)70658-1 CrossRefPubMedGoogle Scholar
  4. 4.
    Wostmann B, Rasche KR (1995) The influence of radiotherapy on survival time of teeth and restorations. A study on patients with maxillofacial defects. Zahnarztl Welt 104:627Google Scholar
  5. 5.
    Hu JY, Li YQ, Smales RJ, Yip KH (2002) Restoration of teeth with more-viscous glass ionomer cements following radiation-induced caries. Int Dent J 52:445–448PubMedGoogle Scholar
  6. 6.
    McComb D, Erickson RL, Maxymiw WG, Wood RE (2002) A clinical comparison of glass ionomer, resin-modified glass ionomer and resin composite restorations in the treatment of cervical caries in xerostomic head and neck radiation patients. Oper Dent 27:430–437PubMedGoogle Scholar
  7. 7.
    Arnold WH, Konopka S, Kriwalsky MS, Gaengler P (2003) Morphological analysis and chemical content of natural dentin carious lesion zones. Ann Anat 185:419–424. doi: 10.1016/S0940-9602(03)80099-7 CrossRefPubMedGoogle Scholar
  8. 8.
    Gernhardt CR, Kielbassa AM, Hahn P, Schaller HG (2001) Tensile bond strengths of four different dentin adhesives on irradiated and non-irradiated human dentin in vitro. J Oral Rehabil 28:814–820. doi: 10.1046/j.1365-2842.2001.00758.x CrossRefPubMedGoogle Scholar
  9. 9.
    Kidd EA (2001) Diagnosis of secondary caries. J Dent Educ 65:997–1000PubMedGoogle Scholar
  10. 10.
    Dionysopoulos P, Kotsanos N, Koliniotou-Koubia E, Tolidis K (2003) Inhibition of demineralization in vitro around fluoride releasing materials. J Oral Rehabil 30:1216–1222PubMedGoogle Scholar
  11. 11.
    Bonan PR, Lopes MA, Pires FR, Almeida OP (2006) Dental management of low socioeconomic level patients before radiotherapy of the head and neck with special emphasis on the prevention of osteoradionecrosis. Braz Dent J 17:336–342. doi: 10.1590/S0103-64402006000400013 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Alan Roger S. Silva
    • 1
    • 2
  • Fabio A. Alves
    • 3
    • 4
  • Sandrine B. Berger
    • 2
    • 5
  • Marcelo Giannini
    • 2
    • 6
  • Mario F. Goes
    • 2
    • 5
  • Marcio A. Lopes
    • 1
    • 2
    • 7
    Email author
  1. 1.Oral Pathology Department (Semiology Area), Piracicaba Dental SchoolCampinas State University (UNICAMP)PiracicabaBrazil
  2. 2.PiracicabaBrazil
  3. 3.Department of StomatologyCancer Hospital A.C. CamargoSão PauloBrazil
  4. 4.São PauloBrazil
  5. 5.Department of Restorative Dentistry (Dental Materials Area), Piracicaba Dental SchoolCampinas State University (UNICAMP)PiracicabaBrazil
  6. 6.Department of Restorative Dentistry (Dentistry Area), Piracicaba Dental SchoolCampinas State University (UNICAMP)PiracicabaBrazil
  7. 7.Department of Oral Diagnosis, Semiology AreaPiracicaba Dental School (UNICAMP)PiracicabaBrazil

Personalised recommendations