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Radiogene Karies: Ätiologie und Möglichkeiten der Prävention

Was sollte der Strahlentherapeut wissen?

Radiation-related caries: etiology and possible preventive strategies

What should the radiotherapist know?

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Zusammenfassung

Hintergrund

Nach radiotherapeutischer Behandlung maligner Tumoren im Kopf-Hals-Bereich bleibt die Frage nach der oftmals posttherapeutisch beeinträchtigten Lebensqualität aktuell. Nach Abschluss der Strahlentherapie lässt sich bei den meisten Patienten eine sogenannte Strahlenkaries beobachten. Die Hälfte aller infizierten Osteoradionekrosen im Kieferbereich steht im unmittelbaren Zusammenhang mit einer Strahlenkaries. Im vorliegenden Review sollen das aktuelle Wissen zur Ätiologie und Pathogenese sowie Strategien zur Vermeidung und Behandlung besprochen werden.

Material und Methoden

Es wurde eine PubMed-Recherche der Literatur unter den Suchbegriffen „radiogene Karies“ („radiation related caries“, „radiation related damage to dentition“) und „Strahlenkaries“ („postradiation caries“, „dental complications and radiotherapy“) durchgeführt, deren Inhalt sich mit der Ätiologie der Erkrankung, der Pathogenese und der sich daraus ergebenden Möglichkeiten der Prävention und Therapie beschäftigte.

Ergebnisse

Für das Review wurden 60 Publikationen ausgewählt. Als Ursachen einer radiogenen Karies werden sowohl indirekt das sich verändernde orale Milieu, z. B. durch die radiogene Xerostomie, als auch direkte radiogene Schäden an den Zahnhartsubstanzen diskutiert. Die Strahlenkaries stellt eine lebenslange Bedrohung dar und erfordert demzufolge immerwährende Präventionsmaßnahmen.

Schlussfolgerungen

Um eine optimale Versorgung des Patienten sowohl im Verlauf der Strahlentherapie als auch danach gewährleisten zu können, ist eine enge interdisziplinäre Zusammenarbeit zwischen Strahlentherapeuten, Mund-Kiefer-Gesichtschirurgen, HNO-Ärzten und Zahnärzten unbedingt notwendig.

Abstract

Background

After radiation treatment of head-and-neck cancer, the impairment of patient’s quality of life still remains an issue. After completion of the treatment course, a substantial number of patients develop so-called radiation caries. In addition, almost 50% of all cases of infectious osteoradionecrosis (iORN) of the jaws are directly associated with radiation caries. This review addresses our current knowledge on the etiology and pathogenesis of radiation caries including possible preventive strategies.

Materials and methods

A PubMed search using the terms “radiation caries” (“radiation related caries”, “radiation related damage to dentition”) and “radiogenic caries” (“postradiation caries”, “dental complications and radiotherapy”) was performed. The analysis of its content focused on the etiology, the pathogenesis, and the available knowledge on prophylaxis as well as treatment of radiation caries.

Results

For this review, 60 publications were selected. As main causal factors for radiogenic caries, either indirect impairment, resulting from alterations in the oral environment (e.g., radiation-induced xerostomia) or direct radiation-induced damage in teeth hard tissues are discussed. Radiation caries remains a lifelong threat and, therefore, requires permanent prevention programs.

Conclusion

To enable optimal medical care of the patients during the time course of radiotherapy as well as afterwards, close interdisciplinary cooperation between radiotherapists, oral surgeons, otorhinolaryngologists, and dentists is absolutely essential.

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Authors and Affiliations

  1. Universitätspoliklinik für Prothetik, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland

    R. Schweyen & J. Hey

  2. Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland

    W. Fränzel

  3. Universitätsklinik und Poliklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland

    D. Vordermark

  4. Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Rostock (AöR), Südring 75, 18059, Rostock, Deutschland

    G. Hildebrandt &  T. Kuhnt

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  1. R. Schweyen
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Correspondence to T. Kuhnt.

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Schweyen, R., Hey, J., Fränzel, W. et al. Radiogene Karies: Ätiologie und Möglichkeiten der Prävention. Strahlenther Onkol 188, 21–28 (2012). https://doi.org/10.1007/s00066-011-0011-1

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