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The influence of parotid gland sparing on radiation damages of dental hard tissues

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Abstract

Objective

The aim of the present study was to evaluate whether radiation damage on dental hard tissue depends on the mean irradiation dose the spared parotid gland is subjected to or on stimulated whole salivary flow rate.

Material and methods

Between June 2002 and October 2008, 70 patients with neck and cancer curatively irradiated were included in this study. All patients underwent dental treatment referring to the guidelines and recommendations of the German Society of Dental, Oral and Craniomandibular Sciences prior, during, and after radiotherapy (RT). During the follow-up period of 24 months, damages on dental hard tissues were classified according to the RTOG/EORTC guidelines. The mean doses (D mean) during spared parotid gland RT were determined. Stimulated whole saliva secretion flow rates (SFR) were measured before RT and 1, 6, 12, 24 months after RT.

Results

Thirty patients showed no carious lesions (group A), 18 patients developed sporadic carious lesions (group B), and 22 patients developed general carious lesions (group C). Group A patients received a D mean of 21.2 ± 11.04 Gy. Group B patients received a D mean of 26.5 ± 11.59 Gy and group C patients received a D mean of 33.9 ± 9.93 Gy, respectively. The D mean of group A was significantly lower than the D mean of group C (p < 0.001). Additionally, the mean SFR 6 months after RT of group A was significantly higher than the mean SFR of group C (p < 0.01).

Conclusions

Irradiation damage on dental hard tissue correlates with increased mean irradiation doses as well as decreased salivary flow rates.

Clinical relevance

Parotid gland sparing resulting in a dose below 20 Gy reduces radiation damage on dental hard tissues, and therefore, the dose may act as a predictor for the damage to be expected.

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References

  1. Schweyen R, Hey J, Fränzel W, Vordermark D, Hildebrandt G, Kuhnt T (2012) Radiation-related caries: etiology and possible preventive strategies. What should the radiotherapist know? Strahlenther Onkol 188:21–28

    Article  PubMed  Google Scholar 

  2. Spak CJ, Johnson G, Ekstrand J (1994) Caries incidence, salivary flow rate and efficacy of fluoride gel treatment in irradiated patients. Caries Res 28:388–393

    Article  PubMed  Google Scholar 

  3. Chao KS, Majhail N, Huang CJ, Simpson JR, Perez CA, Haughey B, Spector G (2001) Intensity-modulated radiation therapy reduces late salivary toxicity without compromising tumor control in patients with oropharyngeal carcinoma: a comparison with conventional techniques. Radiother Oncol 61:275–280

    Article  PubMed  Google Scholar 

  4. Jensen SB, Pedersen AM, Reibel J, Nauntofte B (2003) Xerostomia and hypofunction of the salivary glands in cancer therapy. Support Care Cancer 11:207–225

    PubMed  Google Scholar 

  5. Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, Purdy JA, Low DA (2001) A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys 49:907–916

    Article  PubMed  Google Scholar 

  6. Parliament MB, Scrimger RA, Anderson SG, Kurien EC, Thompson HK, Field GC, Hanson J (2004) Preservation of oral health-related quality of life and salivary flow rates after inverse-planned intensity-modulated radiotherapy (IMRT) for head-and-neck cancer. Int J Radiat Oncol Biol Phys 58:663–673

    Article  PubMed  Google Scholar 

  7. Gomez DR, Estilo CL, Wolden SL, Zelefsky MJ, Kraus DH, Wong RJ, Shaha AR, Shah JP, Mechalakos JG, Lee NY (2011) Correlation of osteoradionecrosis and dental events with dosimetric parameters in intensity-modulated radiation therapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 81:e207–e213

    Article  PubMed  Google Scholar 

  8. Hey J, Setz J, Gerlach R, Janich M, Sehlleier S, Schaller HG, Gernhardt CR, Kuhnt T (2009) Parotid-gland sparing 3D conformal radiotherapy in patients with bilateral radiotherapy of the head and neck region—results in clinical practice. Oral Oncol 45:e11–e17

    Article  PubMed  Google Scholar 

  9. Hey J, Setz J, Gerlach R, Janich M, Hildebrandt G, Vordermark D, Gernhardt CR, Kuhnt T (2011) Parotid gland-recovery after radiotherapy in the head and neck region—36 months follow-up of a prospective clinical study. Radiat Oncol 6:125

    Article  PubMed  Google Scholar 

  10. Kuhnt T, Janich M, Gotz U, Gerlach R, Chiricuta IC, Hansgen G (2006) Presentation of a 3D conformal radiotherapy technique for head-and-neck tumors resulting in substantial protection of the parotid glands. Strahlenther Onkol 182:325–330

    Article  PubMed  Google Scholar 

  11. Georg D, Kroupa B, Georg P, Winkler P, Bogner J, Dieckmann K, Pötter R (2006) Inverse planning—a comparative intersystem and interpatient constraint study. Strahlenther Onkol 182:473–480

    Article  PubMed  Google Scholar 

  12. International Commission on Radiation Units and Measurements (1993) ICRU 50: prescribing and reporting photon beam therapy. Inc ICRU News 1:1–72

    Google Scholar 

  13. International Commission on Radiation Units and Measurements (1999) ICRU 62: prescribing, recording and reporting photon beam therapy (supplement to ICRU Report 50). Inc ICRU News 1:1–8

    Google Scholar 

  14. Lyman JT, Wolbarst AB (1989) Optimization of radiation therapy, IV: a dose-volume histogram reduction algorithm. Int J Radiat Oncol Biol Phys 17:433–436

    Article  PubMed  Google Scholar 

  15. Burlage FR, Coppes RP, Meertens H, Stokman MA, Vissink A (2001) Parotid and submandibular/sublingual salivary flow during high dose radiotherapy. Radiother Oncol 61:271–274

    Article  PubMed  Google Scholar 

  16. Dawes C (1987) Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man. J Dent Res 66:648–653

    PubMed  Google Scholar 

  17. Witter DJ, van Palenstein Helderman WH, Creugers NH, Kayser AF (1999) The shortened dental arch concept and its implications for oral health care. Community Dent Oral Epidemiol 27:249–258

    PubMed  Google Scholar 

  18. Kielbassa AM, Hinkelbein W, Hellwig E, Meyer-Luckel H (2006) Radiation-related damage to dentition. Lancet Oncol 7:326–335

    Article  PubMed  Google Scholar 

  19. Grotz KA, Riesenbeck D, Brahm R, Seegenschmiedt MH, Al-Nawas B, Dorr W, Kutzner J, Willich N, Thelen M, Wagner W (2001) Chronic radiation effects on dental hard tissue (radiation caries). Classification and therapeutic strategies. Strahlenther Onkol 177:96–104

    Article  PubMed  Google Scholar 

  20. Franzel W, Gerlach R, Hein HJ, Schaller HG (2006) Effect of tumor therapeutic irradiation on the mechanical properties of teeth tissue. Z Med Phys 16:148–154

    PubMed  Google Scholar 

  21. Walker MP, Wichman B, Cheng AL, Coster J, Williams KB (2011) Impact of radiotherapy dose on dentition breakdown in head and neck cancer patients. Pract Radiat Oncol 1:142–148

    Article  PubMed  Google Scholar 

  22. Kielbassa AM (2000) In situ induced demineralization in irradiated and non-irradiated human dentin. Eur J Oral Sci 108:214–221

    Article  PubMed  Google Scholar 

  23. Kielbassa AM, Hellwig E, Meyer-Lueckel H (2006) Effects of irradiation on in situ remineralization of human and bovine enamel demineralized in vitro. Caries Res 40:130–135

    Article  PubMed  Google Scholar 

  24. Karbach J, Walter C, Al-Nawas B (2012) Evaluation of saliva flow rates, Candida colonization and susceptibility of Candida strains after head and neck radiation. Clin Oral Investig 16:1305–1312

    Article  PubMed  Google Scholar 

  25. Ghezzi EM, Lange LA, Ship JA (2000) Determination of variation of stimulated salivary flow rates. J Dent Res 79:1874–1878

    Article  PubMed  Google Scholar 

  26. Veerman EC, van den Keybus PA, Vissink A, Nieuw Amerongen AV (1996) Human glandular salivas: their separate collection and analysis. Eur J Oral Sci 104:346–352

    Article  PubMed  Google Scholar 

  27. Beer KT, Zehnder D, Lussi A, Greiner RH (2002) Sparing of contralateral major salivary glands has a significant effect on oral health in patients treated with radical radiotherapy of head and neck tumors. Strahlenther Onkol 178:722–726

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Prosthetic Dentistry, University School of Dental Medicine, Martin-Luther-University Halle-Wittenberg, Große Steinstraße 19, 06108, Halle, Germany

    Jeremias Hey, Johannes Seidel & Ramona Schweyen

  2. Department of Psychology, Julius-Maximilians-University Würzburg, Marcusstraße 9-11, 97070, Würzburg, Germany

    Yvonne Paelecke-Habermann

  3. Department of Radiotherapy, University Clinic, Martin-Luther-University Halle-Wittenberg, Dryanderstraße 4, 06110, Halle, Germany

    Dirk Vordermark

  4. Department of Operative Dentistry and Periodontology, University School of Dental Medicine, Martin-Luther-University Halle-Wittenberg, Große Steinstraße 19, 06108, Halle, Germany

    Christian Gernhardt

  5. Department of Radiotherapy, University Clinic, Südring 75, 18059, Rostock, Germany

    Thomas Kuhnt

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  1. Jeremias Hey
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  2. Johannes Seidel
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  3. Ramona Schweyen
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  4. Yvonne Paelecke-Habermann
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  5. Dirk Vordermark
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  6. Christian Gernhardt
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  7. Thomas Kuhnt
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Correspondence to Jeremias Hey.

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Hey, J., Seidel, J., Schweyen, R. et al. The influence of parotid gland sparing on radiation damages of dental hard tissues. Clin Oral Invest 17, 1619–1625 (2013). https://doi.org/10.1007/s00784-012-0854-6

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  • DOI: https://doi.org/10.1007/s00784-012-0854-6

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