[Histotomography studies of direct radiogenic dental enamel changes]

The volume of literature on radiation-induced caries is still inconsistent as regards the state of the art. Our histotomographic studies have shown direct radiogenic effects on the dentoenamel junction (atrophy of the odontoblast processes). Whether there are direct effects of radiation on dental enamel is not yet known.

Sound teeth (group 1, n = 10) were compared either with enamel specimens after high dose in vitro radiation (500-2500 Gy; group 2; n = 10) and after experimental enoral in situ irradiation (60 Gy; group 3; n = 20), or with teeth from patients after cancer radiotherapy (36 Gy; group 4; n = 20) and with teeth which had obviously decayed due to cancer radiotherapy (60 Gy; group 5; n = 20). Vestibular enamel surfaces of the teeth were exposed to identical in vitro demineralizations (lactic acid gel; pH = 5.0). Each of the samples was prospectively studied histologically by confocal laser scanning microscopy (CLSM) after 90, 180 and 270 min of acid interaction. Data were interpreted micromorphometrically (width of the demineralized area) and micromorphologically.

The width of the demineralized area varies between the two in vivo irradiated groups of specimens (group 4: P < 0.01; group 5: P < 0.001) and the high dose in vitro irradiated teeth (P < 0.01) and is significantly different from the sound controls. The histological image of the demineralization in subsurface areas in the teeth of radiotherapy patients is characterized by a total loss of the prismatic structure (homogeneously, amorphous substance).

Direct radiogenic effects at the dentoenamel junction have been described earlier. The additional information offered by this study is that there are significant micromorphometric differences in the demineralizing behaviour of irradiated enamel. Obviously, enamel is less resistant to acid attack after irradiation.