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VOLUME 16 , ISSUE 8 ( August, 2015 ) > List of Articles


The Effects of Ionizing Radiation on the Oral Cavity

Sandra Ribeiro de Barros da Cunha, Pedro Augusto Mendes Ramos, Ana Cristina Aló Nesrallah, Cláudia Joffily Parahyba, Eduardo Rodrigues Fregnani, Ana Cecília Corrêa Aranha

Citation Information : da Cunha SR, Ramos PA, Nesrallah AC, Parahyba CJ, Fregnani ER, Aranha AC. The Effects of Ionizing Radiation on the Oral Cavity. J Contemp Dent Pract 2015; 16 (8):679-687.

DOI: 10.5005/jp-journals-10024-1740

Published Online: 01-02-2016

Copyright Statement:  Copyright © 2015; The Author(s).



The aim of this study is to present a literature review on the effects of the ionizing radiation from radiotherapy treatment on dental tissues.


Among the effects of increasing global life expectancy and longevity of the teeth in the oral cavity, increasing rates of neoplastic diseases have been observed. One of the important treatment modalities for head and neck neoplastic diseases is radiotherapy, which uses ionizing radiation as the main mechanism of action. Therefore, it is essential for dentists to be aware of the changes in oral and dental tissues caused by ionizing radiation, and to develop treatment and prevention strategies.


In general, there is still controversy about the effects of ionizing radiation on dental structures. However, qualitative and quantitative changes in saliva and oral microbiota, presence of oral mucositis and radiation-related caries are expected, as they represent the well-known side effects of treatment with ionizing radiation. Points that still remain unclear are the effects of radiotherapy on enamel and dentin, and on their mechanisms of bonding to contemporary adhesive materials.


Ionizing radiation has shown important interaction with organic tissues, since more deleterious effects have been shown on the oral mucosa, salivary glands and dentin, than on enamel.

Clinical significance

With the increasing number of patients with cancer seeking dental treatment before and after head and neck radiotherapy, it is important for dentists to be aware of the effects of ionizing radiation on the oral cavity.

How to cite this article

de Barros da Cunha SR, Ramos PAM, Nesrallah ACA, Parahyba CJ, Fregnani ER, Aranha ACC. The Effects of Ionizing Radiation on the Oral Cavity. J Contemp Dent Pract 2015;16(8):679-687.

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  1. Effects of gamma radiation on hard dental tissues of albino rats: investigation by light microscopy. Radiat Environ Biophys 2013 Aug;52(3):375-387.
  2. Intensity-modulated radiation therapy for head and neck cancer: systematic review and meta-analysis. Radiother Oncol 2014;110(1):9-15.
  3. Radioproteção e Dosimetria: Fundamentos. Rio de Janeiro: IRD/CNEN; 2003. 263 p. (Port)
  4. Long-term outcomes of submandibular gland transfer for prevention of postradiation xerostomia. Arch Otolaryngol Head Neck Surg 2004 Aug;130(8):956-961.
  5. Braz J Otorhinolaryngol 2006 Sep-Oct;72(5):704-708.
  6. Radiation-related damage to dentition. Lancet Oncol 2006 Apr;7(4):326-335.
  7. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 2001;12(2):127136.
  8. The effect of radiotherapy on dental hard tissue—a systematic review. Clin Oral Investig 2014 Jan;18(1):17-24.
  9. Remineralization of enamel by a saliva substitute designed for use by irradiated patients. Cancer 1978 May;41(5):1746-1750.
  10. Radiation apoptosis of serous acinar cells of salivary and lacrimal glands. Cancer 1991 Mar 15;67(6):1539-1543.
  11. Manifestations and treatment of xerostomia and associated oral effects secondary to head and neck radiation therapy. J Am Dent Assoc 1997 Aug;128(8):1128-1133.
  12. The enigmatic mechanism of irradiation-induced damage to the major salivary glands. Oral Dis 2002 May;8(3):141-146.
  13. es CS, Sensi LG, Freire AR. A review of the biological and clinical aspects of radiation caries. J Contemp Dent Pract 2009 Jul 1;10(4):83-89.
  14. Effects of irradiation on in situ remineralization of human and bovine enamel demineralized in vitro. Caries Res 2006;40(2):130-135.
  15. Dental plaque pH and micro-organisms during hyposalivation. J Dent Res 2006 Apr;85(4):334-338.
  16. Risk factors for oropharyngeal candidiasis in patients who receive radiation therapy for malignant conditions of the head and neck. Oral Surg Oral Med Oral Pathol 1993 Aug;76(2):169-174.
  17. The role of saliva in maintaining oral health and as an aid to diagnosis. Med Oral Pathol Oral Cir Bucal 2006 Aug;11(5):E449-455.
  18. Review of preclinical studies on treatment of mucositis and associated pain. J Dent Res 2014 Sep;93(9):868-875.
  19. Impact of radiotherapy dose on dentition breakdown in head and neck cancer patients. Pract Radiat Oncol 2011;1(3):142-148.
  20. Maxillofacial rehabilitation: prosthodontic and surgical considerations. Prosthodontic Procedures: Complete Dentures; St Louis: Ishiyaku Euro America Inc; 1996. p. 101-102.
  21. Maxillofacial rehabilitation: prosthodontic and surgical considerations. Preradiation Extractions: Current Philosophies and Literature Review, St Louis: Ishiyaku Euro America Inc; 1996. p. 74-78.
  22. Current management of oral cancer. A multidisciplinary approach. J Am Dent Assoc 2001;132suppl:19S-23.
  23. Management of radiotherapy-induced salivary hypofunction and consequent xerostomia in patients with oral or head and neck cancer: meta-analysis and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2014 May;117(5):595-607.
  24. The causes and consequences of hyposalivation. Ear Nose Throat J 1988 Mar;67(3):166-168.
  25. Dental complications of head and neck radiotherapy: Part 1. Aust Dent J 2001 Jun;46(2):88-94.
  26. lito O Jr. Evaluation of salivary flow in patients during head and neck radiotherapy. Pesqui Odontol Bras 2003 Apr-Jun;17(2):156-160.
  27. A prospective study of salivary gland function in patients undergoing radiotherapy for squamous cell carcinoma of the oropharynx. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97(2):173-189.
  28. Radiation therapy of the oral cavity: sequelae and management, part 1. Head Neck Surg 1979 Mar-Apr;1(4):301-312.
  29. Prevention and treatment of the orofacial complications of radiotherapy. J Am Dent Assoc 1987 Mar;114(3):316-322.
  30. Risk factors for oropharyngeal candidiasis in patients who receive radiation therapy for malignant conditions of the head and neck. Oral Surg Oral Med Oral Pathol 1993 Aug;76(2):169-174.
  31. A pilot study of the clinical effects of irradiation on the oral tissues. Br J Oral Maxillofac Surg 1984 Apr;22(2):77-86.
  32. Oral complications of radiotherapy. Lancet Oncol 2006 Feb;7(2):175-183.
  33. Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients. Support Care Cancer 2013 Nov;21(11):3191-3207.
  34. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2014 May 15;120(10):1453-1461.
  35. Do acute mucosal reactions lead to consequential late reactions in patients with head and neck cancer? Radiother Oncol 1999 Aug;52(2):157-164.
  36. Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: a narrative review. Nutrients 2015 Jan 5;7(1):265-276.
  37. Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 2003;14(3):199-212.
  38. cek G, Kova.cs G, Suhr M, Wiltfang J, Y. Radiation caries radiogenic destruction of dental collagen. Oral Oncol 2005;41(7):723-728.
  39. Histologic effect of fractionated doses of selectively applied 60 Co irradiation on the teeth of albino rats. J Dent Res 1977;56(11):1403-1407.
  40. Effects of gamma radiation on incisor development of the prenatal albino mouse. J Oral Pathol Med 1991 Sep;20(8):385-358.
  41. Effect of gamma radiation on bonding to human enamel and dentin. Support Care Cancer 2012 Nov;20(11):2873-2878.
  42. Patterns of demineralization and dentin reactions in radiation-related caries. Caries Res 2009;43(1):43-49.
  43. Caries incidence, salivary flow rate and efficacy of fluoride gel treatment in irradiated patients. Caries Res 1994;28(5):388-393.
  44. Compliance with fluoride gel use in irradiated patients. Spec Care Dentist 1995;15(6):218-222.
  45. Two-year clinical performance of glass ionomer and resin composite restorations in xerostomic head- and neck-irradiated cancer patients. Clin Oral Investig 2011 Feb;15(1):31-38.
  46. In vivo study on the prevention of postradiation caries. Caries Res 1989;23(3):172-178.
  47. Xerostomiarelated caries. Dutch J Dent 1992;99:225-232.
  48. Radiation-related caries and early restoration failure in head and neck cancer patients. A polarized light microscopy and scanning electron microscopy study. Support Care Cancer 2010 Jan;18(1):83-87.
  49. Restoration of teeth with more-viscous glass ionomer cements following radiationinduced caries. Int Dent J 2002;52(6):445-448.
  50. The influence of dentin adhesives on the demineralization of irradiated and non-irradiated human root dentin. Oper Dent 2004;29(4):454-461.
  51. A clinical comparison of glass ionomer, resin-modified ionomer and resin composite restorations in the treatment of cervical caries in xerostomic head and neck radiation patients. Oper Dent 2002;27(5):430-437.
  52. Surface hardness and wear of glass ionomers and compomers. Am J Dent 1997;10(1):15-17.
  53. Effect of gamma irradiation on ultimate tensile strength of enamel and dentin. J Dent Res 2010 Feb;89(2):159-164.
  54. An experimental study of the stability of irradiated teeth in the region of the dentinoenamel junction. Endod Dent Traumatol 1992 Dec;8(6):241-242.
  55. In vitro dentine hardness following gamma-irradiation and freezing. J Dent 1999 Sep;27(7):503-507.
  56. Natural and induced radiation caries: A SEM study. Am J Dent 1993 Jun;6(3):130-136.
  57. Microradiographic and microscopic studies on in situ induced initial caries in irradiated and nonirradiated dental enamel. Caries Res 2000 Jan-Feb;34(1):41-47.
  58. Radiation therapy alters microhardness and microstructure of enamel and dentin of permanent human teeth. J Dent 2014 Aug;42(8):986-992.
  59. New evidence for the etiology of so-called radiation caries. Proof for directed radiogenic damage of the enamel-dentin junction. Strahlenther Onkol 1997 Dec;173(12):668-676.
  60. Effect of tumor therapeutic irradiation on the mechanical properties of teeth tissue. Z Med Phys 2006;16(2):148-154.
  61. Effect of X-ray irradiation on the permeability of bovine dental enamel. Caries Res 1990;24(3):164-168.
  62. Structure and composition of enamel. Oper Dent 1992; suppl 5:10-17.
  63. Irradiation effects on microhardness of fluoridated and non-fluoridated bovine dentin. Eur J Oral Sci 1997 Oct;105(5):444-447.
  64. The effect of X-radiation on the susceptibility of enamel to an artificial caries-like attack in vitro. J Dent 1985 Mar;13(1):41-44.
  65. nting J, Hellwig E. Correlation of transversal microradiography and microhardness on in situ-induced demineralization in irradiated and nonirradiated human dental enamel. Arch Oral Biol 1999 Mar;44(3):243-251.
  66. The effect of radiation therapy on the mechanical and morphological properties of the enamel and dentin of deciduous teeth—an in vitro study. Radiat Oncol 2014;22:30.
  67. Morphological analysis and chemical content of natural dentin carious lesion zones. Ann Anat 2003 Oct;185(5):419-424.
  68. Optical coherence tomography as an auxiliary tool for the screening of radiation-related caries. Photomed Laser Surg 2013 Jul;31(7):301-306.
  69. Radiotherapy does not impair dentin adhesive properties in head and neck cancer patients. Clin Oral Investig 2014 Sep;18(7):1771-1778.
  70. Radiotherapy-induced mandibular bone complications. Cancer Treat Rev 2002;28(1):65-74.
  71. Osteoradionecrosis of the jaws-a current overview: Part 2: dental management and therapeutic options for treatment. Oral Maxillofac Surg 2010;14(2):81-95.
  72. Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofacial Surg 2008;46(8):653-660.
  73. Intensity-modulated radiation therapy for oropharyngeal cancer: radiation dosage constraint at the anterior mandible. Oral Oncol 2009;45(6):511-514.
  74. Oral and dental health care of oral cancer patients: hyposalivation, caries and infections. Oral Oncol 2010;46(6):464-467.
  75. Intensity-modulated radiotherapy versus conventional and 3D conformal radiotherapy in patients with head and neck cancer: is there a worthwhile quality of life gain? Cancer Treat Rev 2011;37(7):511-519.
  76. Oral complications of cancer and cancer therapy. From cancer treatment to survivorship. CA Cancer J Clin 2012;62(6):400-422.
  77. Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 1983;41(5):283-288.
  78. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients—a report of a thirty year retrospective review. Int J Oral Maxillofac Surg 2003;32(3):289-295.
  79. DNA-DNA hybridization demonstrates multiple bacteria in osteoradionecrosis. Int J Oral Maxillofac Surg 2005;34(2):193-196.
  80. Osteoradionecrosis of the mandible: Etiology, prevention, diagnosis and treatment. Ind J Plast Surg 2007;40(12):65-71.
  81. Imaging of the head and neck following radiation treatment. Pathol Res Int 2011;2011:Article ID 607820.
  82. Osteoradionecrosis. Int J Head Neck Surg 2011;2(1):27-32.
  83. Dosimetric distribution to the tooth-bearing regions of the mandible following intensity-modulated radiation therapy for base of tongue cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114(2):e50-54.
  84. Osteoradionecrosis of the jaws: clinical characteristics and relation to the field of irradiation. J Oral Maxillofac Surg 2000;58(10):1088-1093.
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