Thiel H J
Radiobiol Radiother (Berl). 1989;30(3):193-211.
Two mechanisms are discussed regarding etiology and pathogenesis: the direct mechanism by radioeffect on teeth, lying in irradiation field, and the indirect mechanism by alteration of the secretion from salivary glands (hypo- and dyssalivation, xerostomia), alteration of the physiological mouth-flora (dominance of Streptococcus mutans) and deficient mouth and tooth hygiene by the patients. Clinically four types of radiogenic tooth defects are discerned: the superficial carious destruction of the necks of the teeth, the change of the tooth-colour to brown-black, an early gradual fuse of the edges and occlusal plane of teeth and generalised superficial defects. With the tumor diagnosis and before the beginning of radiotherapy a total dental examination of the whole mouth-cavity is to do. The therapeutic measures conform to the dimension of dental caries and the bone reduction in consequence of parodontopathies. On principle as many teeth as possible are restored and preserved, only all teeth, that can not be restored in fact and have an uncertain prognosis, are extracted selectively considering a most careful atraumatic surgical technique. The programme for mouth hygienics and tooth prophylaxis carrying out during and for many years after radiotherapy includes a careful and routine cleaning of teeth of films and tartar, frequent rinsing of the mouth with Bepanthene-, Subcutin- or sodium chloride-sodium bicarbonate solution, daily fluoride-dose by mean of fluorine gel or gel carrier, a thorough instruction and motivation of the patients and an after-care in short intervals, to recognize a reduction of cooperation, to diagnose complications as soon as possible and to begin a suitable therapy. Extraction of teeth after radiotherapy was contraindicated absolutely in the past because of the risk of following osteoradionecroses. Recent reports however show, that the risk of a postradiotherapeutic tooth extraction is not so high as suspected primarily, if the indication is paid attention to and the extraction is done according respected technical regulations. Special care has to be given to manufacture and fitting in artificial teeth. It has not to be done until all essential therapeutic effects are eased off, that usually occurs 1 to 1 1/2 years after the end of therapy.
一种是对位于照射野内牙齿的直接放射效应机制，另一种是间接机制，包括唾液腺分泌改变（唾液分泌减少和分泌异常、口干症）、生理性口腔菌群改变（变形链球菌占优势）以及患者口腔和牙齿卫生不良。临床上可识别出四种放射性牙齿缺陷类型：牙齿颈部的浅表龋坏、牙齿颜色变为棕黑色、牙齿边缘和咬合面早期逐渐融合以及广泛性浅表缺损。在肿瘤诊断时以及放疗开始前，应对整个口腔进行全面的牙齿检查。治疗措施根据龋齿的程度和牙周病导致的骨质减少情况而定。原则上应尽可能修复和保留牙齿，仅对那些实际上无法修复且预后不确定的牙齿，在考虑最小心的无创伤手术技术的情况下进行选择性拔除。放疗期间及放疗后多年进行口腔卫生和牙齿预防的方案包括仔细常规清洁牙齿上的菌斑和牙石、用拜耳万能膏、皮下脂肪或氯化钠 - 碳酸氢钠溶液频繁漱口、通过氟凝胶或凝胶载体每日给予氟剂量、对患者进行全面指导和激励以及短时间间隔的后续护理，以识别合作度降低情况、尽快诊断并发症并开始适当治疗。过去，由于担心随后发生放射性骨坏死，放疗后绝对禁忌拔牙。然而，最近的报告显示，如果注意适应症并按照严格的技术规范进行拔牙，放疗后拔牙的风险并不像最初怀疑的那么高。制作和安装假牙时必须格外小心。直到所有基本治疗效果缓解后才能进行，这通常在治疗结束后1至1.5年出现。
