放射性龋形成机制的研究进展
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摘要
放射性龋坏是头颈部癌放疗后最常见的并发症,它是在放疗后发生的一种进展快速、范围广泛的牙体组织破坏性疾病。目前认为,唾液腺功能障碍、放射线对牙齿的直接破坏等是放射性龋坏的主要致病因素。本文将从放射性龋坏发病机制,尤其是放疗对口腔龋病相关微生物的影响等研究进行综述,并对今后的研究方向进行展望。通过现有的研究结果发现,放疗后口腔微生物组结构发生明显变化,一些龋病相关微生物如变异链球菌、乳杆菌、白色念珠菌等数量及比例升高,毒力增强,说明放疗引起的口腔微生物的变化在放射性龋中扮演着重要的角色。
Radioactive caries is the most common complication of head and neck cancer after radiotherapy. It is a rapidly progressing and widespread destructive disease of tooth tissue after radiotherapy. It is currently believed that sal?ivary gland dysfunction and direct damage to teeth by radiation are the main pathogenic factors of radiation caries. In this paper, the pathogenesis of radiation caries, especially the effect of radiotherapy on oral caries?related microorgan?isms, are reviewed, and future research directions are proposed. Existing research has revealed that the structures of oral microorganisms change significantly after radiotherapy. The number and proportion of some dental caries?related mi?croorganisms such as Streptococcus mutans, Lactobacillus lactis and Candida albicans increased, and their virulence in?creased. This indicated that the changes in oral microorganisms caused by radiotherapy played an important role in ra?dioactive caries.
Radioactive caries is the most common complication of head and neck cancer after radiotherapy. It is a rapidly progressing and widespread destructive disease of tooth tissue after radiotherapy. It is currently believed that sal?ivary gland dysfunction and direct damage to teeth by radiation are the main pathogenic factors of radiation caries. In this paper, the pathogenesis of radiation caries, especially the effect of radiotherapy on oral caries?related microorgan?isms, are reviewed, and future research directions are proposed. Existing research has revealed that the structures of oral microorganisms change significantly after radiotherapy. The number and proportion of some dental caries?related mi?croorganisms such as Streptococcus mutans, Lactobacillus lactis and Candida albicans increased, and their virulence in?creased. This indicated that the changes in oral microorganisms caused by radiotherapy played an important role in ra?dioactive caries.
引文
[1] Dobros K, Hajto?Bryk J, Wróblewska M, et al. Radiation?induced caries as the late effect of radiation therapy in the head and neck region[J]. Contemp Oncol, 2016, 20(4):287?290.
[2] Aguiar GP, Jham BC, Cláudia S Magalh?es, et al. A review of the biological and clinical aspects of radiation caries[J]. J Contemp Dent Pract, 2009, 10(4):83?89.
[3] Deng J, Jackson L, Epstein JB, et al. Dental demineralization and caries in patients with head and neck cancer[J]. Oral Oncol, 2015,51(9):824?831.
[4] Galv?omoreira LV, Da CM. Dental demineralization, radiation car?ies and oral microbiota in patients with head and neck cancer[J].Oral Oncol, 2015, 51(12):89?90.
[5] Sood AJ, Fox NF, O'Connell BP, et al. Salivary gland transfer to prevent radiation?induced xerostomia:a systematic review and me?ta?analysis.[J]. Oral Oncol, 2014, 50(2):77?83.
[6] Delli K, Spijkervet FKL, Kroese FGM, et al. Xerostomia[J]. Nip?pon Rinsho, 2014, 24(7):1614?1618.
[7] De FF, Tombolini M, Musella A, et al. Radiation therapy and se?rum salivary amylase in head and neck cancer[J]. Oncotarget,2017, 8(52):90496.
[8] Konings AW, Coppes RP, Vissink A. On the mechanism of sali?vary gland radiosensitivity[J]. Int J Radiat Oncol Biol Phys, 2005,62(4):1187?1194.
[9] Liu X, Gong B, Souza LBD, et al. Radiation inhibits salivary gland function by promoting STIM1 cleavage by caspase?3 and loss of SOCE through a TRPM2?dependent pathway[J]. Sci Signal, 2017,10(482). doi:10.1126/scisignal.aal4064.
[10] Sciubba JJ, Goldenberg D. Oral complications of radiotherapy[J].Lancet Oncol, 2006, 7(2):175?183.
[11] Raychaudhuri A, Shah K, Porter RJ. The oral management of pa?tients who have received radiotherapy to the head and neck region[J]. Br Dent J, 2013, 214(8):387?393.
[12] Reed R, Xu C, Liu Y, et al. Radiotherapy effect on nano?mechani?cal properties and chemical composition of enamel and dentine[J].Arch. Oral Biol, 2015, 60(5):690?697.
[13] Lieshout HFJ, Bots CP. The effect of radiotherapy on dental hard tissue—a systematic review[J]. Clin Oral Investig, 2014, 18(1):17?24.
[14] Naves LZ, Novais VR, Armstrong SR, et al. Effect of gamma radia?tion on bonding to human enamel and dentin[J]. Support Care Can?cer 2012; 20(11):2873?2878.
[15] Liang X, Zhang JY, Cheng IK, et al. Effect of high energy X?ray ir?radiation on the nano?mechanical properties of human enamel and dentine[J]. Braz Oral Res, 2016, 30(1). doi:10.1590/1807?3107BOR?2016.vol30.0009.
[16] McGuire JD, Gorski JP, Dusevich V, et al. Type IV collagen is a novel DEJ biomarker that is reduced by radiotherapy. J Dent Res,2014, 93(10):1028?1034.
[17] Seyedmahmoud R, Wang Y, Thiagarajan G, et al. Oral cancer ra?diotherapy affects enamel microhardness and associated indenta?tion pattern morphology[J]. Clin Oral Investig, 2017(3):1?9.
[18] Soares CJ, Castro CG, Neiva NA, et al. Effect of gamma irradiation on ultimate tensile strength of enamel and dentin. J Dent Res,2010, 89(2):159?164.
[19] Nguyen HM, Reyland ME, Barlow LA. Mechanisms of taste bud cell loss after head and neck irradiation[J]. J Neurosci, 2012, 32(10):3474?84.
[20] Negi P, Kingsley PA, Thomas M, et al. Pattern of gustatory impair?ment and its recovery after head and neck irradiation[J]. Iran J Otorhinolaryngol, 2017, 29(95):319?327.
[21] Tsutsumi R, Goda M, Fujimoto C, et al. Effects of chemotherapy on gene expression of lingual taste receptors in patients with head and neck cancer[J]. Laryngoscope, 2016, 126(3):e103?e109.
[22] Zaura E, Nicu EA, Krom BP, et al. Acquiring and maintaining a normal oral microbiome:current perspective[J]. Front Cell Infect Microbiol, 2014, 4(4):85.
[23] Abusleme L, Dupuy AK, Dutzan N, et al. The subgingival microbi?ome in health and periodontitis and its relationship with communi?ty biomass and inflammation[J]. ISME J, 2013, 7(5):1016?1025.
[24] Kielbassa AM, Hinkelbein W, Hellwig E, et al. Radiation?related damage to dentition[J]. Lancet Oncol, 2006, 7(4):326?335.
[25] Brown LR, Dreizen S, Handler S, et al. Effect of radiation?induced xerostomia on human oral microflora[J]. J Dent Res, 1975, 54:740?750.
[26] Eliasson L, Carlen A, Almstahl A, et al. Dental plaque pH and mi?cro?organisms during hyposalivation[J]. J Dent Res, 2006, 85(4):334?338.
[27] He J, Li Y, Cao Y, et al. The oral microbiome diversity and its rela?tion to human diseases[J]. Folia Microbiol, 2015, 60(1):69?80.
[28] Hu YJ, Shao ZY, Wang Q, et al. Exploring the dynamic core micro?biome of plaque microbiota during head?and?neck radiotherapy us?ing pyrosequencing[J]. PLoS one, 2013, 8(2):e56343.
[29] Gao L, Hu Y, Wang Y, et al. Exploring the variation of oral micro?biota in supragingival plaque during and after head?and?neck ra?diotherapy using pyrosequencing[J]. Arch Oral Biol, 2015, 60(9):1222?1230.
[30] Krzysciak W, Jurczak A, Koscielniak D, et al. The virulence of Streptococcus mutans, and the ability to form biofilms[J]. Eur J Clin Microbiol Infect Dis, 2014, 33(4):499?515.
[31] Metwalli KH, Khan SA, Krom BP, et al. Streptococcus mutans,Candida albicans, and the human mouth:a sticky situation[J].PLoS Pathog, 2013, 9(10):e1003616.
[32] Keene HJ, Fleming TJ, Toth BB. Cariogenic microflora in patients with Hodgkin's disease before and after mantle field radiotherapy[J]. Oral Surg Oral Med Oral Pathol, 1994, 78(5):577?582.
[33] Meng L, Liu J, Peng B, et al. The persistence of Streptococcus mu?tans in nasopharyngeal carcinoma patients after radiotherapy[J].Caries Res, 2005, 39(6):484?489.
[34] Santosh ABR, Ogle OE, Williams D, et al. Epidemiology of oral and maxillofacial infections[J]. Dent Clin North Am, 2017, 61(2):217?233.
[35] Epstein JB, Chin EA, Jacobson JJ, et al. The relationships among fluoride, cariogenic oral flora, and salivary flow rate during radia?tion therapy[J]. Oral Surg Oral Med Oral Pathol Oral Radiol En?dod, 1998, 86(3):286?292.
[36] Agarwal P, Upadhyay R, Agarwal A. Radiotherapy complications and their possible management in the head and neck region[J]. In?dian J Dent Res, 2012, 23(6):843.
[37] Joyston?Bechal S, Hayes K, Davenport ES, et al. Caries incidence,Mutans Streptococci and Lactobacilli in irradiated patients during a 12?months preventive programme using chlohrexidine and fluo?ride[J]. Caries Res, 1992, 26:384?390.
[38] Shrestha M, Boaz K, Srikant N, et al. An assessment of candidal colonization and species differentiation in head and neck cancer patients receiving radiation[J]. J Nepal Health Res Counc, 2014,12(28):156?161.
[39] Raja M, Hannan A, Ali K. Association of oral Candidal carriage with dental caries in children[J]. Caries Res, 2010, 44(3):272?276.
[40] Yang XQ, Zhang Q, Lu LY, et al. Genotypic distribution of Candi?da albicans in dental biofilm of Chinese children associated with severe early childhood caries[J]. Arch. Oral Biol, 2012, 57(8):1048?1053.
[41] Koo H, Bowen WH. Candida albicans and Streptococcus mutans:a potential synergistic alliance to cause virulent tooth decay in chil?dren[J]. Future Microbiol, 2014, 9(12):1295?1297.
[42] Srithavaj T, Thaweboon S. Determination of oral microflora in irra?diated ocular deformed children[J]. Southeast Asian J Trop Med Public Health, 2006, 37(5):991?995.
[43] Almst?hl A, Wikstr?m M, Fagerberg?Mohlin B. Microflora in oral ecosystems in subjects with radiation?induced hyposalivation[J].Oral Dis, 2008, 14(6):541?549.
[44] Belazi M, Velegraki A, Koussidoueremondi T, et al. Oral Candida isolates in patients undergoing radiotherapy for head and neck cancer:prevalence, azole susceptibility profiles and response to antifungal treatment[J]. Oral Microbiol Immunol, 2004, 19(6):347?351.
[45] Ueta E, Tanida T, Yoneda K, et al. Increase of Candida cell viru?lence by anticancer drugs and irradiation[J]. Oral Microbiol Immu?nol, 2001, 16(4):243?249.
[2] Aguiar GP, Jham BC, Cláudia S Magalh?es, et al. A review of the biological and clinical aspects of radiation caries[J]. J Contemp Dent Pract, 2009, 10(4):83?89.
[3] Deng J, Jackson L, Epstein JB, et al. Dental demineralization and caries in patients with head and neck cancer[J]. Oral Oncol, 2015,51(9):824?831.
[4] Galv?omoreira LV, Da CM. Dental demineralization, radiation car?ies and oral microbiota in patients with head and neck cancer[J].Oral Oncol, 2015, 51(12):89?90.
[5] Sood AJ, Fox NF, O'Connell BP, et al. Salivary gland transfer to prevent radiation?induced xerostomia:a systematic review and me?ta?analysis.[J]. Oral Oncol, 2014, 50(2):77?83.
[6] Delli K, Spijkervet FKL, Kroese FGM, et al. Xerostomia[J]. Nip?pon Rinsho, 2014, 24(7):1614?1618.
[7] De FF, Tombolini M, Musella A, et al. Radiation therapy and se?rum salivary amylase in head and neck cancer[J]. Oncotarget,2017, 8(52):90496.
[8] Konings AW, Coppes RP, Vissink A. On the mechanism of sali?vary gland radiosensitivity[J]. Int J Radiat Oncol Biol Phys, 2005,62(4):1187?1194.
[9] Liu X, Gong B, Souza LBD, et al. Radiation inhibits salivary gland function by promoting STIM1 cleavage by caspase?3 and loss of SOCE through a TRPM2?dependent pathway[J]. Sci Signal, 2017,10(482). doi:10.1126/scisignal.aal4064.
[10] Sciubba JJ, Goldenberg D. Oral complications of radiotherapy[J].Lancet Oncol, 2006, 7(2):175?183.
[11] Raychaudhuri A, Shah K, Porter RJ. The oral management of pa?tients who have received radiotherapy to the head and neck region[J]. Br Dent J, 2013, 214(8):387?393.
[12] Reed R, Xu C, Liu Y, et al. Radiotherapy effect on nano?mechani?cal properties and chemical composition of enamel and dentine[J].Arch. Oral Biol, 2015, 60(5):690?697.
[13] Lieshout HFJ, Bots CP. The effect of radiotherapy on dental hard tissue—a systematic review[J]. Clin Oral Investig, 2014, 18(1):17?24.
[14] Naves LZ, Novais VR, Armstrong SR, et al. Effect of gamma radia?tion on bonding to human enamel and dentin[J]. Support Care Can?cer 2012; 20(11):2873?2878.
[15] Liang X, Zhang JY, Cheng IK, et al. Effect of high energy X?ray ir?radiation on the nano?mechanical properties of human enamel and dentine[J]. Braz Oral Res, 2016, 30(1). doi:10.1590/1807?3107BOR?2016.vol30.0009.
[16] McGuire JD, Gorski JP, Dusevich V, et al. Type IV collagen is a novel DEJ biomarker that is reduced by radiotherapy. J Dent Res,2014, 93(10):1028?1034.
[17] Seyedmahmoud R, Wang Y, Thiagarajan G, et al. Oral cancer ra?diotherapy affects enamel microhardness and associated indenta?tion pattern morphology[J]. Clin Oral Investig, 2017(3):1?9.
[18] Soares CJ, Castro CG, Neiva NA, et al. Effect of gamma irradiation on ultimate tensile strength of enamel and dentin. J Dent Res,2010, 89(2):159?164.
[19] Nguyen HM, Reyland ME, Barlow LA. Mechanisms of taste bud cell loss after head and neck irradiation[J]. J Neurosci, 2012, 32(10):3474?84.
[20] Negi P, Kingsley PA, Thomas M, et al. Pattern of gustatory impair?ment and its recovery after head and neck irradiation[J]. Iran J Otorhinolaryngol, 2017, 29(95):319?327.
[21] Tsutsumi R, Goda M, Fujimoto C, et al. Effects of chemotherapy on gene expression of lingual taste receptors in patients with head and neck cancer[J]. Laryngoscope, 2016, 126(3):e103?e109.
[22] Zaura E, Nicu EA, Krom BP, et al. Acquiring and maintaining a normal oral microbiome:current perspective[J]. Front Cell Infect Microbiol, 2014, 4(4):85.
[23] Abusleme L, Dupuy AK, Dutzan N, et al. The subgingival microbi?ome in health and periodontitis and its relationship with communi?ty biomass and inflammation[J]. ISME J, 2013, 7(5):1016?1025.
[24] Kielbassa AM, Hinkelbein W, Hellwig E, et al. Radiation?related damage to dentition[J]. Lancet Oncol, 2006, 7(4):326?335.
[25] Brown LR, Dreizen S, Handler S, et al. Effect of radiation?induced xerostomia on human oral microflora[J]. J Dent Res, 1975, 54:740?750.
[26] Eliasson L, Carlen A, Almstahl A, et al. Dental plaque pH and mi?cro?organisms during hyposalivation[J]. J Dent Res, 2006, 85(4):334?338.
[27] He J, Li Y, Cao Y, et al. The oral microbiome diversity and its rela?tion to human diseases[J]. Folia Microbiol, 2015, 60(1):69?80.
[28] Hu YJ, Shao ZY, Wang Q, et al. Exploring the dynamic core micro?biome of plaque microbiota during head?and?neck radiotherapy us?ing pyrosequencing[J]. PLoS one, 2013, 8(2):e56343.
[29] Gao L, Hu Y, Wang Y, et al. Exploring the variation of oral micro?biota in supragingival plaque during and after head?and?neck ra?diotherapy using pyrosequencing[J]. Arch Oral Biol, 2015, 60(9):1222?1230.
[30] Krzysciak W, Jurczak A, Koscielniak D, et al. The virulence of Streptococcus mutans, and the ability to form biofilms[J]. Eur J Clin Microbiol Infect Dis, 2014, 33(4):499?515.
[31] Metwalli KH, Khan SA, Krom BP, et al. Streptococcus mutans,Candida albicans, and the human mouth:a sticky situation[J].PLoS Pathog, 2013, 9(10):e1003616.
[32] Keene HJ, Fleming TJ, Toth BB. Cariogenic microflora in patients with Hodgkin's disease before and after mantle field radiotherapy[J]. Oral Surg Oral Med Oral Pathol, 1994, 78(5):577?582.
[33] Meng L, Liu J, Peng B, et al. The persistence of Streptococcus mu?tans in nasopharyngeal carcinoma patients after radiotherapy[J].Caries Res, 2005, 39(6):484?489.
[34] Santosh ABR, Ogle OE, Williams D, et al. Epidemiology of oral and maxillofacial infections[J]. Dent Clin North Am, 2017, 61(2):217?233.
[35] Epstein JB, Chin EA, Jacobson JJ, et al. The relationships among fluoride, cariogenic oral flora, and salivary flow rate during radia?tion therapy[J]. Oral Surg Oral Med Oral Pathol Oral Radiol En?dod, 1998, 86(3):286?292.
[36] Agarwal P, Upadhyay R, Agarwal A. Radiotherapy complications and their possible management in the head and neck region[J]. In?dian J Dent Res, 2012, 23(6):843.
[37] Joyston?Bechal S, Hayes K, Davenport ES, et al. Caries incidence,Mutans Streptococci and Lactobacilli in irradiated patients during a 12?months preventive programme using chlohrexidine and fluo?ride[J]. Caries Res, 1992, 26:384?390.
[38] Shrestha M, Boaz K, Srikant N, et al. An assessment of candidal colonization and species differentiation in head and neck cancer patients receiving radiation[J]. J Nepal Health Res Counc, 2014,12(28):156?161.
[39] Raja M, Hannan A, Ali K. Association of oral Candidal carriage with dental caries in children[J]. Caries Res, 2010, 44(3):272?276.
[40] Yang XQ, Zhang Q, Lu LY, et al. Genotypic distribution of Candi?da albicans in dental biofilm of Chinese children associated with severe early childhood caries[J]. Arch. Oral Biol, 2012, 57(8):1048?1053.
[41] Koo H, Bowen WH. Candida albicans and Streptococcus mutans:a potential synergistic alliance to cause virulent tooth decay in chil?dren[J]. Future Microbiol, 2014, 9(12):1295?1297.
[42] Srithavaj T, Thaweboon S. Determination of oral microflora in irra?diated ocular deformed children[J]. Southeast Asian J Trop Med Public Health, 2006, 37(5):991?995.
[43] Almst?hl A, Wikstr?m M, Fagerberg?Mohlin B. Microflora in oral ecosystems in subjects with radiation?induced hyposalivation[J].Oral Dis, 2008, 14(6):541?549.
[44] Belazi M, Velegraki A, Koussidoueremondi T, et al. Oral Candida isolates in patients undergoing radiotherapy for head and neck cancer:prevalence, azole susceptibility profiles and response to antifungal treatment[J]. Oral Microbiol Immunol, 2004, 19(6):347?351.
[45] Ueta E, Tanida T, Yoneda K, et al. Increase of Candida cell viru?lence by anticancer drugs and irradiation[J]. Oral Microbiol Immu?nol, 2001, 16(4):243?249.