Cracked tooth syndrome one year after head and neck radiotherapy

The left lateral mandibular incisor (tooth 32) of a patient with base of tongue cancer submitted to adjuvant radiotherapy (RT) was assessed during mouth conditioning protocol and followed up 1, 3, 6, 9, and 12 months post-RT. Enamel craze lines (ECL) were assessed using a pen-sized cordless transillumination device. ImageJ software was used to analyze the number and size of ECLs before and 1 year post-RT. The tooth measured 8.8 mm. Analysis 1 year post-RT revealed a 100% increase in the number of ECLs (from 8 to 16). All existing ECLs increased in size. The largest ECL measured 8.46 mm and the smallest was 0.76 mm. Seven of 8 new ECLs appeared on the tooth cervical area. Results support ECL as part of the initial spectrum of radiation-related caries (RRC). Increased ECLs revealed weakened tooth structure post-RT. Dentists should be aware of the presence of ECL in patients with head and neck cancer post-RT to promote prevention and early diagnosis and management of RRC. The left lateral mandibular incisor (tooth 32) of a patient with base of tongue cancer submitted to adjuvant radiotherapy (RT) was assessed during mouth conditioning protocol and followed up 1, 3, 6, 9, and 12 months post-RT. Enamel craze lines (ECL) were assessed using a pen-sized cordless transillumination device. ImageJ software was used to analyze the number and size of ECLs before and 1 year post-RT. The tooth measured 8.8 mm. Analysis 1 year post-RT revealed a 100% increase in the number of ECLs (from 8 to 16). All existing ECLs increased in size. The largest ECL measured 8.46 mm and the smallest was 0.76 mm. Seven of 8 new ECLs appeared on the tooth cervical area. Results support ECL as part of the initial spectrum of radiation-related caries (RRC). Increased ECLs revealed weakened tooth structure post-RT. Dentists should be aware of the presence of ECL in patients with head and neck cancer post-RT to promote prevention and early diagnosis and management of RRC.