Clinical and therapeutical aspects of rampant caries in cervico-facial irradiated patients.

The irradiant cervico-facial therapy produces numerous complications in maxillo-facial territory, among which the most frequent are: xerostomia, osteonecrosis, mucosal degeneration and severe rampant caries. This is the reason why a written report must exist between the dentist and the radiologist, with all data of the radiological treatment, which implies the patient follow-up from a stomatologic point of view before, during and after the application of the irradiate treatment. We studied a group of patients that followed an X-ray treatment, determining the salivary flow, the physical and chemical feature of the saliva and bacterial flora before, during the X-ray treatment with different doses and at the end of the treatment and at certain periods of time. The rampant caries were found in 46% of cases and interested the cervical zones, the incisal edges and the cusps, zones that are usually resisting at caries. The irradiation produced an important decrease of the repose and activated salivary flow (under 0.1 mL/min), of the buffering capacity of saliva. Also, the saliva became more viscous and the total quantity of proteins increased. The microbial flora is modified with the increasing level of Streptococcus mutans and Lactobacillus. In 23% of patients the secretion returned to normal at 3 weeks from the irradiation, at the other it was irreversible, as a result of a radiation-induced damage to the salivary glands (the atrophy through the increasing of radiant dose). The treatment was different, depending on the clinical condition of the patient and the disease prognosis. It is recommended the compulsory use of the prophylactic treatment. The authors suggest their treatment planning that includes the reduction of the microbial flora, the change of alimentary diet and salivary stimulates or substitutes. These prevent the appearing of rampant caries that will require ample restorations.