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The clinical effect of radiotherapy on pulpal microvasculature: a systematic review


Introduction/objectives Radiotherapy (RT) has a detrimental effect on the histomorphology of oral tissues. Patients undergoing RT are at risk of developing macrovascular and microvascular changes, which can lead to significant clinical consequences. Despite advances in RT delivery systems, radiation injury remains a modern-day clinical problem. The aim of this systematic review is to investigate the available evidence regarding the impact of RT to the dental pulp and the clinical manifestations of these effects.

Data and sources A multi-database search (PubMed, Medline, Embase and CINAHL) was performed to identify related papers published from inception until November 2021. An additional manual search was performed to identify further articles. The data extracted from relevant papers were analysed according to the outcomes selected in this review.

Study selection The search generated seven articles eligible for analysis with a total of 2,709 teeth included. RT dose exposure ranged from 30-71.2 Gray with a common finding that RT decreases the number of teeth responding to pulp sensibility testing.

Conclusions Knowledge related to the impact of RT on dental pulp is limited and based on weak evidence and a low-level quality of studies. Future studies should incorporate exact RT doses to the teeth and use replicable pulpal testing methods. Understanding the pulpal status post-RT remains an important consideration as dental extractions should be avoided in this cohort due to the risk of osteoradionecrosis.

Key points

  • Increasing survivorship of the head and neck cancer patient requires a functioning dentition.

  • Head and neck radiotherapy risk should be considered based upon tumour sub-sites.

  • Radiation delivery that involves the teeth may give false pulpal status influenced by radiotherapy dose and time since treatment.

  • The pulpal status post head and neck radiotherapy is important considering extractions should be avoided.

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Authors and Affiliations



Rana Wali and Vinod Patel conceived the presented systematic review idea and the design of the study. Rana Wali and Roberto Sacco contributed to the acquisition, analysis and the interpretation of data for the work; Rana Wali, Roberto Sacco and Vinod Patel drafted the paper and revised it critically; Gurpreet Singh provided an endodontic perspective and revised the paper, Rana Wali, Roberto Sacco, Gurpreet Singh and Vinod Patel approved the final version to be published.

Corresponding author

Correspondence to Vinod Patel.

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Ethical approval is not applicable as this is a systematic review of papers (not involving human participants or clinical intervention).

The authors declare no conflicts of interest.

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Wali, R., Sacco, R., Singh, G. et al. The clinical effect of radiotherapy on pulpal microvasculature: a systematic review. Br Dent J (2022).

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