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Authors
Abstract(s)
Introdução: Durante a utilização das técnicas de diagnóstico radiológico em
Medicina Dentária, a mucosa oral está diretamente exposta a radiação ionizante,
um agente reconhecidamente mutagénico e cancerígeno.
Objetivo: Averiguar a existência de uma eventual relação entre a utilização de
técnicas de diagnóstico radiológico em medicina dentária e a ocorrência de
alterações citogenéticas na mucosa oral.
Material e métodos: Revisão sistemática realizada através da metodologia
PRISMA, tendo por base os critérios PICO. A busca foi realizada nos bancos de
dados PubMed e Web of Science, usando uma expressão de busca baseada nos
seguintes termos MeSH: (Mouth mucosa) AND ((Chromosome Aberrations) OR
(Cytogenetic Analysis) OR (Cytogenetics) OR (DNA damage) OR (Mutagenicity
Tests)) AND ((Dental radiography) OR ((Dentistry) AND (Diagnostic imaging))).
Resultados: Dos 246 registos obtidos através da pesquisa nos motores de
busca, foram selecionados 30 artigos. A maior parte dos estudos envolveu o uso
de Radiografia panorâmica (PAN) (63,3%), foi realizada em células esfoliadas da
mucosa oral (50,0%) com amostragem antes (controlo) e após irradiação,
maioritariamentea 10 dias (56,7%). Na larga maioria dos estudos (66,7%)
procedeu-se a análise citológica com determinação da frequência de
micronúcleos (MN) e de alterações nucleares degenerativas (picnose, cariólise e
cariorrexia). Em todos os estudos, independentemente da técnica imagiológica
radiográfica utilizada, a irradiação diagnóstica foi associada a aumentos
significativos (p < 0,05) em pelo menos um dos parâmetros indicadores de
citotoxicidade. A maioria de estudos considerados evidenciou ainda resultados
positivos para genotoxicidade (46,7%). Na análise estratificada por técnica
radiológica e por endpoint analisado, verificou-se uma maior frequência de
resultados positivos para genotoxicidade em estudos envolvendo o uso de CBCT
(23,3% vs 63,3% na radiografia panorâmica) e em estudos empregando o ensaio
cometa (10,0% vs 86,7% na análise da frequência de MN).
Conclusão: De acordo com os estudos incluídos nesta revisão sistemática, a
utilização de técnicas de diagnóstico radiológico em medicina dentária está
IV
associada a alterações citotóxicas e, eventualmente, genotóxicas na mucosa oral.
Considerando a frequência de utilização destas técnicas, são necessários mais
estudos para confirmar uma eventual genotoxicidade das mesmas e o reforço de
medidas que minimizem os efeitos deletérios destas técnicas de ampla utilização
e utilidade clínica indiscutível.
Introduction: During the use of radiological diagnostic techniques in dentistry, the oral mucosa is directly exposed to ionizing radiation, a mutagenic agent. Objective: To investigate the existence of a possible relationship between the use of diagnostic radiological techniques in dentistry and the occurrence of cytogenetic changes in the oral mucosa. Material and methods: Systematic review conducted using the PRISMA methodology, based on PICO criteria. The search was performed in PubMed and Web of Science databases, using a search expression based on the following MeSH terms: (Mouth mucosa) AND ((Chromosome Aberrations) OR (Cytogenetic Analysis) OR (Cytogenetics) OR (DNA damage) OR (Mutagenicity Tests)) AND ((Dental radiography) OR ((Dentistry) AND (Diagnostic imaging))). Results: From the 246 records obtained by searching the search engines, 30 articles were selected. Most studies resulted from the use of Panoramic Radiography (PAN) (63.3%), were performed on exfoliated cells of the oral mucosa (50.0%), with pre-irradiation (control) and post-irradiation sampling, mostly 10 days after irradiation (56.7%). In the vast majority of studies (66.7%), cytological analysis was performed to determine the frequency of micronuclei (MN) and degenerative nuclear changes (pyknosis, karyolysis and karyorrhexis). In all studies, regardless of the radiographic imaging technique used, diagnostic irradiation was associated with significant increases (p < 0.05) in at least one of the cytotoxicity indicator parameters. Most studies considered also showed positive results for genotoxicity (46.7%). Upon stratification analysis, a higher frequency of positive genotoxicity results was observed for CBCT-based studies (23,3% vs 63,3% for panoramic radiography) and for comet assay-based results (10,0% vs 86,7% for MN frequency analysis). Conclusion: According to the studies included in this systematic review, the use of radiological diagnostic techniques in dentistry is associated with cytotoxic and, eventually, genotoxic alterations in the oral mucosa. Considering the frequency of use of these techniques, further studies are needed to confirm their possible genotoxicity and policy changes are needed to reinforce measures to minimize the deleterious effects of these vastly used techniques of indisputable clinical utility.
Introduction: During the use of radiological diagnostic techniques in dentistry, the oral mucosa is directly exposed to ionizing radiation, a mutagenic agent. Objective: To investigate the existence of a possible relationship between the use of diagnostic radiological techniques in dentistry and the occurrence of cytogenetic changes in the oral mucosa. Material and methods: Systematic review conducted using the PRISMA methodology, based on PICO criteria. The search was performed in PubMed and Web of Science databases, using a search expression based on the following MeSH terms: (Mouth mucosa) AND ((Chromosome Aberrations) OR (Cytogenetic Analysis) OR (Cytogenetics) OR (DNA damage) OR (Mutagenicity Tests)) AND ((Dental radiography) OR ((Dentistry) AND (Diagnostic imaging))). Results: From the 246 records obtained by searching the search engines, 30 articles were selected. Most studies resulted from the use of Panoramic Radiography (PAN) (63.3%), were performed on exfoliated cells of the oral mucosa (50.0%), with pre-irradiation (control) and post-irradiation sampling, mostly 10 days after irradiation (56.7%). In the vast majority of studies (66.7%), cytological analysis was performed to determine the frequency of micronuclei (MN) and degenerative nuclear changes (pyknosis, karyolysis and karyorrhexis). In all studies, regardless of the radiographic imaging technique used, diagnostic irradiation was associated with significant increases (p < 0.05) in at least one of the cytotoxicity indicator parameters. Most studies considered also showed positive results for genotoxicity (46.7%). Upon stratification analysis, a higher frequency of positive genotoxicity results was observed for CBCT-based studies (23,3% vs 63,3% for panoramic radiography) and for comet assay-based results (10,0% vs 86,7% for MN frequency analysis). Conclusion: According to the studies included in this systematic review, the use of radiological diagnostic techniques in dentistry is associated with cytotoxic and, eventually, genotoxic alterations in the oral mucosa. Considering the frequency of use of these techniques, further studies are needed to confirm their possible genotoxicity and policy changes are needed to reinforce measures to minimize the deleterious effects of these vastly used techniques of indisputable clinical utility.
Description
Keywords
Medicina dentária Técnicas de diagnóstico radiológico Alterações citogenéticas Mucosa oral Dentistry Diagnostic radiological techniques Cytogenetic alterations Oral mucosa