Kielbassa Andrej M, Hinkelbein Wolfgang, Hellwig Elmar, Meyer-Lückel Hendrik
Department of Operative Dentistry and Periodontology, University School of Dental Medicine, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Lancet Oncol. 2006 Apr;7(4):326-35. doi: 10.1016/S1470-2045(06)70658-1.
Because of typical tissue reactions to ionising radiation, radiotherapy in the head and neck region usually results in complex oral complications affecting the salivary glands, oral mucosa, bone, masticatory musculature, and dentition. When the oral cavity and salivary glands are exposed to high doses of radiation, clinical consequences including hyposalivation, mucositis, taste loss, trismus, and osteoradionecrosis should be regarded as the most common side-effects. Mucositis and taste loss are reversible consequences, usually subsiding early post-irradiation, whereas hyposalivation is commonly irreversible. Additionally, the risk of rampant tooth decay with its sudden onset and osteonecrosis is a lifelong threat. Thus, early, active participation of the dental profession in the development of preventive and therapeutic strategies, and in the education and rehabilitation of patients is paramount in consideration of quality-of-life issues during and after radiotherapy. This Review focuses on the multifactorial causes of so-called radiation caries and presents possible treatment strategies to avoid loss of dentition.
由于头部和颈部组织对电离辐射的典型反应,头颈部放疗通常会导致复杂的口腔并发症,影响唾液腺、口腔黏膜、骨骼、咀嚼肌和牙列。当口腔和唾液腺受到高剂量辐射时,临床后果包括唾液分泌减少、黏膜炎、味觉丧失、牙关紧闭和放射性骨坏死,应被视为最常见的副作用。黏膜炎和味觉丧失是可逆的后果,通常在放疗后早期消退,而唾液分泌减少通常是不可逆的。此外,猖獗性龋齿及其突然发作和骨坏死的风险是终身威胁。因此,考虑到放疗期间和放疗后的生活质量问题,牙科专业人员尽早积极参与预防和治疗策略的制定以及患者的教育和康复至关重要。本综述重点关注所谓放射性龋齿的多因素成因,并提出避免牙列丧失的可能治疗策略。