Chronic radiation effects on dental hard tissue ("Radiation caries"). Classification and therapeutic strategies

Objectives: Since the first description of rapid destruction of dental hard tissues following head and neck radiotherapy 80 years ago, "radiation cari es" is an established clinical finding. The internationally accepted clinic al evaluation score RTOG/EORTC however is Lacking a classification of this frequent radiogenic alteration. Material and Methods: Medical records, data and images of radiation effects on the teeth of more than 1,500 patients, who underwent periradiotherapeut ic care, were analyzed. Macroscopic alterations regarding the grade of Late Lesions of tooth crowns were used for a classification into 4 grades accor ding to the RTOG/EORTC guidelines. Results: No early radiation effects were found by macroscopic inspection. I n the first 90 days following radiotherapy 1/3 of the patients complained o f reversible hypersensitivity, which may be related to a temporary hyperemi a of the pulp. It was possible to classify radiation caries as a Late radia tion effect on a graded scale as known from RTOG/EORTC for other organ syst ems. This is a prerequisite for the integration of radiation caries into th e international nomenclature of the RTOG/EORTC classification. Conclusions: The documentation of early radiation effects on dental hard ti ssues seems to be neglectable. On the other hand the documentation of Late radiation effects has a high clinical impact. The identification of an init ial Lesion at the high-risk areas of the neck and incisal part of the tooth can Lead to a successful therapy as a major prerequisite for orofacial reh abilitation. An internationally standardized documentation is a basis for t he evaluation of the side effects of radiooncotic therapy as well as the ef fectiveness of protective and supportive procedures.