RADIOBIOLOGY

DR D. BARDHAN
HDCH
DEPT OF OMR
 CONTENTS
Definition

Types of radiation hazards

Effects on cellular level

Factors determining

Effect on oral structures

DEFINITION:
Radiation biology is the study of effects of ionizing
radiation on living system.

TYPES OF EFFECTS:
1. Direct
2. Indirect

Initial changes due to modifications of biologic

molecules may result in alterations of cells and
organs that may persist for hours,days even
generations and may result in death of cells or
organs.
DIRECT EFFECT:
energy of photon

Transfer of energy directly to the

biological molecules

DIRECT EFFECT
INVOLVES THREE STEPS:
1. Absorption of energy by the biological
molecule

2. Transfer of energy between unstable

intermediate molecules

3. Formation of unstable free radicals, they

cause immense damage to our cellular
systems
INDIRECT EFFECTS:

photon is absorbed by water in body

Water molecules are ionized & form

free radicals

Induce biological effects

 Water is the predominant molecule in the
biological systems .It frequently participates
in the interactions between xray photons
and the biologic molecules . The hydrogen
and hydroxyl free radical present in the
water interacts with the organic molecule
resulting in for
 Approximately one-third of the biologic
effects of xray result from direct effect .
 The rest is from indirect effect .
CHANGES IN CELLULAR LEVEL

IN THE D.N.A:-
1. Changes in a base
2. Disruption of the hydrogen bonds between
DNA strands
3. Breakage of one or more dna strands
4. Cross linking of DNA strands with in the
helix to other proteins
PROTEINS:
1. Breakage of hydrogen or disulfide bonds
leads to denaturation of proteins
2. Intermolecular and intramolecular cross
linking

NUCLEUS:
Nucleus is more radiosensitive than the
cytoplasm especially in dividing cells .
DNA structure are sensitive sites in the
nucleus.
CHROMOSOMAL DEFECTS
Chromosome serves as markers for radiation
injury.If radiation exposure occours after DNA
synthesis ,only one arm of the affected
chromosome is broken.
If radiation ocours before DNA synthesis ,the
damage manifests as a break in both arms.
Such radiation induced aberations may result
in unequal distribution of chromatin material
to daughter cells .
CYTOPLASM:
Permeability,swelling,disorganization is
increased.
RADIATION EFFECTS AT TISSUE LEVEL:
1. NON STOCHIASTIC
2. STOCHIASTIC

 NON STOCHIASTIC EFFECTS:

Definite or specific damaging effects to the
body of the person exposed to the high dose
of radiation .The severity of the disease is
directly proportional to the dose received.
 STOCHIASTIC EFFECTS:
The chances or probability of radiation effects
may or may not be affecting the person
Eg: leukemia
MODIFYING FACTORS FOR RADIATION
INJURY:

DOSE

DOSE RATE

OXYGEN

LINEAR ENERGY TRANSFER

RADIATION EFFECTS ON THE ORAL CAVITY

 ORAL MUCOUS MEMBRANE

 During irradiation

mucositis – oral mucous membrane shows areas

of redness and inflammation
desquammated epithelial layer - mucous
membrane begin to breakdown , with the
formation of a white to yellow psuedomembrane
Severe mucositis – develops as irradiation continues
which makes mastication difficult
 Infection - Infection of the oral cavity develops
due to bad oral hygiene .
 Secondary infection by candida albicans .

AFTER IRRADIATION –
 Mucosa begins to heal rapidly by about two

months .
 Later mucosa becomes atrophic , thin and

avascular .
 Atrophy develops due to obliteration of the fine

vasculature and fibrosis of the connective tissue

 Ulcer results from a denture sore ,radiation
necrosis or tumour recurrence .
What happens to the taste bud ?
a) Degeneration of taste buds

b) loss of taste sensation

Bitter and acid flavours are more severely
affected when posterior two third of tongue is
irradiated . Anterior one third of tongue when
irradiated causes loss of salt and sweet
sensation . Recovery of taste buds requires at
least 60 – 120 days after irradiation .
 SALIVARY GLANDS

 Parotid glands are more sensitive than the

submandibular and the sublingual lingual
glands .
 A) progressive loss of salivary secreation
 B) XEROSTOMIA - dryness of mouth .
 C) swallowing is difficult and painful because
the residual saliva loses its normal
lubricating properties .
 Ph and buffering capacities of the saliva
falls down
 Histologically ,acute inflammatory response
may occur after the initiation of
therapy .progressive fibrosis , adiposis , loss
of fine vasculature , and degeneration of
parenchyma results in xerostomia .
 Salivary changes influence on the oral
microflora leading to radiation caries by
increase in streptococcus mutans ,
lactobacillus , candida microorganism .

 The thick acidic viscous saliva , which is of
small volume of saliva causes radiation caries
.
 TEETH
 During tooth development period - Retards
the growth of teeth
 Before tooth calcification - Destroy the tooth
bud .
 After tooth calcification - Inhibit cellular
differentiation , causing malformations and
arresting tooth growth .
 Children receiving radiation therapy to the
jaws show defects in the permanent dentition
such as retarded root development ,
dwarfed teeth and anodontia .
 In some instances , irradiation of the
developing teeth after complete calcification
causes premature eruption
 Irradiation of teeth may retard root
formation but no changes in the eruptive
mechanism of teeth .
 Adult teeth are very resistant to the
irradiation
 Pulpal tissue shows fibro atrophy after
irradiation
 Radiation causing no effect on enamel ,
dentine and cementum .
 RADIATION CARIES
 Radiation caries is a rampant form of dental
caries that may occur in individuals who
receive radiotherapy .
 Carious lesion results from changes in the
salivary glands and saliva , including
decreased flow , decreased pH , decrease
buffering capacity and increase viscocity
because of reduced or absent cleansing action
of normal saliova results in accumulation of
debris quickly .

 Clinically 3 types of radiation caries exist
The most common type is widespread
superficial lesions attacking buccal , occlusal
, incisal and palatal surfaces .
Involves the cementum and dentine in the
cervical region .
Dark pigmentation of the entire crown
 TREATMENT PLAN for RADIATION
CARIES -
 A) Daily application of topical 1% sodium
fluoride gel for 5 min in custom made trays .
 Restoration of carious tooth .
 Teeth with gross caries are often extracted
before irradiation .

 BONE
 Irradiation of bone causes damage to the
bone and vasculature of the periosteum and
cortical bone .
 Radiation destroys osteoblasts and to a lesser
extent osteoclasts .
 Bone marrow is replaced with fatty marrow
and fibrous connective tissue .
 Marrow tissue becomes hypovascular ,
hypoxic and hypocellular
 OSTEORADIONECROSIS
 Osteoradionecrosis is the most serious
clinical complication that occurs in bone after
irradiation .
 The decreased vascularity of mandible
renders it easily infected by microorganisms
from oral cavity .
 The bone infection may result from
radiation induced breakdown of mucous
membrane from denture sore on tooth
extraction .
 It is more common in mandible because of
less vascular supply and it is more
frequently exposed to radiation .
 TREATMENT OF OSTEORADIONECROSIS
 Prevent radiation caries by restoring all
carious lesions before irradiation starts .
 Maintains the good oral hygiene .
 Daily topical fluoride application .
 Remove all poorly supported and badly
carious teeth .
 Adjusting dentures to minimize risk of
denture sores
 Hyperbaric oxygen
 Mucocutaneous flaps
 Resection of sequestra or mandibulectomy .
 Nutritional supplements
 Antibiotics and analgesics
Biologic effects of whole body radiation

 When the whole body is exposed to low or

moderate doses of radiation , characteristic
changes occur ( called as acute radiation
syndrone )
 Acute radiation syndrome : It is a collection
of signs and symptoms experienced by the
persons after whole body is exposed to
radiation .
 Clinical manifestations of radiation depend
on the radiation dose .
 1-2 Gy - prodormal symptoms .
 2-4 Gy - Mild hematopoetic symptoms
 4-7 Gy - Severe hematopoetic symptoms
 7-15 Gy - Gastrointestinal symptoms
 50 Gy plus - Cardiovascular and CNS
 PRODORMAL SYMPTOMS
 1-2 Gy dose of radiation develops
anorexia , nausea , vomiting , diarrhoea ,
weakness and fatigue . Severity and time of
onset depends on the dose .
 Severity and time of onset depends on the
dose .
HEMATOPOETIC SYNDROME
 Whole body exposure of 2-7 Gy causes injury
to the hematopoetic stem cells of bone marrow
and spleen causes , fall in the number of
circulating granulocytes , platelets and finally
erythrocytes .
 The clinical signs are infection , hemorrhage
(due to thrombocytopenia ) , Anemia ( due to
depletion of erythrocyte ).
 When death results from hematopoetic
syndrome usually it occurs 10 – 30 days after
irradiation .
GASTROINTESTIONAL SYNDROME
 7-15 Gy of whole body exposure causes loss
of epithelial layer of intestinal mucosae ,
denuded mucosal surface leads to loss of
plasma and electrocytes and reduced
intestinal absorption occurs .
 All these changes are responsible for
diarrhoea , dehydration , and loss of weight .
 Endogeneous intestinal bacteria invade the
denuded surface , producing septicemia .
 CARDIOVASCULAR AND CNS
SYNDROME
 More than 50Gy
 Individual shows intermittent
stupor,incoordination, disorientation and
covulusion suggesting extensive damage to
nervous system
 Death occur within one or two days