Radiotherapy impairs adhesive bonding in permanent teeth.

OBJECTIVES: To evaluate the in vitro effects of radiotherapy (RT) on the morphological surface of the enamel and dentin and to determine the best adhesive system and most appropriate time to restore teeth in head and neck cancer patients. METHODS: Sixty third molars were cut into 120 enamel fragments and 120 dentin fragments and divided into four groups (n = 30): G1 (control): nonirradiated, only restorative procedure; G2: restorative procedure immediately before RT; G3: restorative procedure immediately after RT; and G4: restorative procedure 6 months after RT. Each group was divided into two subgroups: Adper™ Single Bond 2 (SB) and Clearfill SE Bond (CL) based on the material used. After RT and restorative procedures, the specimens were subjected to confocal microscopy and shear bond strength test. Data were analyzed using a two-way ANOVA followed by Tukey's test at a significance level of 5%. RESULTS: Morphological changes were observed in both substrates after a cumulative dose of 40 Gy, and after 60 Gy, the changes were more evident in both substrates. CL had the highest strength values in both substrates (p < 0.05), and G2 had the lowest strength values for the enamel and dentin (p < 0.05). CONCLUSIONS: Based on the in vitro study results, we can conclude that RT substantially changes the morphological surface of enamel and dentin and impairs the bond strength. The Clearfill system yielded better results than Adper Single Bond 2, and restoring teeth before RT resulted in the worst results in both substrates.

Strategies and dental care in the treatment of patients with myelomeningocele.

Myelomeningocele (MMC) is a congenital malformation that occurs in the embryonic period, characterized by failure in closure of the caudal portion of the neural tube during central nervous system formation. Alterations and complications can be associated with this condition, such as hydrocephalus, neurogenic bladder, orthopedic problems, and motor and cognitive impairment. This patients with MMC also have predisposition to develop latex allergy and high caries risk and activity due to deficient oral hygiene, fermentable carbon hydrate-rich diet and prolonged use of sugar-containing oral medications. This paper reports the oral findings and dental treatment in a 15-year-old female patient diagnosed with MMC and describes the strategies used to improve dental treatment conditions and reduce the impact of associated risks to her health. The measures and precautions adopted in this case could be useful to reduce the barriers for patients with the same condition to access oral health care: regular visits to the dentist, initiating as early as possible; frequent reinforcement of oral homecare instructions and diet counseling; minor adaptions to the dental chair and dental office to improve ease of access due to patients' mobility problems; prevention of latex-related allergic reactions; reduction of gag reflex during dental procedures.

The effect of radiation therapy on the mechanical and morphological properties of the enamel and dentin of deciduous teeth--an in vitro study.

PURPOSE: To evaluate the effects of radiation therapy on deciduous teeth. MATERIALS AND METHODS: The enamel and dentin microhardness (n = 12) was evaluated at 3 depths, both before (control) and after each 10 Gy of irradiation and up to a dose of 60 Gy. The morphology was evaluated via scanning electron microscopy (SEM) (n = 8). The data were analyzed using a two-way analysis of variance (ANOVA) and Tukey's test (α = 5%). RESULTS: The enamel microhardness, as a whole, increased (p < 0.05) after a dose of 60 Gy (211.4 KH), mostly in the superficial enamel. There was a significant difference between the values of nonirradiated dentin microhardness (28.9 KH) compared with dentin that was irradiated with doses of 10 Gy (23.8 KH), 20 Gy (25.6 KH), 30 Gy (24.8 KH), and 40 Gy (25.7 KH) (p < 0.05). There was no difference between nonirradiated dentin and dentin irradiated with 60 Gy (p > 0.05). The highest mean value of microhardness (29.9 KH) (p < 0.05) was found in the middle dentin. The groups that were irradiated with doses of 30 and 60 Gy exhibited greater surface changes in their enamel and dentin compared with the nonirradiated groups for all regions, exhibiting an amorphous surface upon increase of the irradiation doses. CONCLUSIONS: The enamel microhardness increased at a dose of 60 Gy, whereas the value of the dentin microhardness did not change. A progressive disruption of enamel and dentin morphology was found with the increased radiation dose.