Background: Radiography is one of the most valuable diagnostic tools used in comprehensive dental care. Radiation from dental radiographs was thought to cause cytogenetic changes and its plausible effects can remain for some hours, months, or generations especially in children.
Aims and objectives: To evaluate and compare the possible genotoxic effect of routinely used intraoral periapical radiographic exposure and radiovisiographic exposure in exfoliated epithelial cells as measured by the formation of micronuclei during single visit pulpectomy procedure using Buccal Micronucleus Cytome (BMCyt) assay in children.
Materials and methods: Study comprised 60 healthy children who has undergone either intraoral periapical radiography (IOPAR; group 1, n = 30) or radiovisiography (RVG; group 2, n = 30) during various steps of single visit pulpectomy procedure. Cytological smears were taken from the buccal mucosa immediately before the X-ray exposure and 10 ± 2 days after exposure. The cells were stained with Feulgen and evaluated for micronuclei by scoring 1,000 cells per sample.
Results: The genotoxic effect of radiation exposure from intraoral periapical radiography higher than that of RVG showing significant increase in micronucleus (MN) formation.
Conclusion: The X-ray radiation emitted during IOPAR or RVG does induce genotoxic changes in the form of increased frequency of micronuclei. So, great care and standard protocol should be followed to advice radiographs if necessary and reduce the cumulated biological effects of radiation exposure.
Keynote: Taking into account the strong evidence of a relationship between DNA damage and carcinogenesis and the extensive application of intraoral radiographs in pediatric dentistry, it would be useful to know to what extent these dental X-rays cause genotoxic effects resulting in DNA damage on oral mucosa.
Fuks AB. Pulp therapy for the primary dentition. In: Pinkham JR, ed. Pediatric Dentistry: Infancy Through Adolescence. 1st ed. Philadelphia, PA: Elsevier; 2005: pp. 333–351.
Agarwal P, Vinuth DP, Haranal S, et al. Genotoxic and cytotoxic effects of X-ray on buccal epithelial cells following panoramic radiography: A pediatric study. J Cytol 2015;32:102–106. DOI: 10.4103/0970-9371.160559
Preethi N, Chikkanarasaiah N, Bethur SS. Genotoxic effects of X-rays in buccal mucosal cells in children subjected to dental radiographs. BDJ Open 2016;2:16001. DOI: 10.1038/bdjopen.2016.1
Thomas P, Holland N, Bolognesi C, et al. Buccal micronucleus cytome assay. Nat Protoc 2009;4:825–837. DOI: 10.1038/nprot.2009.53
Ribeiro DA, De Oliveira G, De Castro GM, et al. Cytogenetic biomonitoring in patients exposed to dental X-rays: comparison between adults and children. Dentomaxillofac Radiol 2008;37:404–407. DOI: 10.1259/dmfr/58548698
Tolbert PE, Shy CM, Allen JW. Micronuclei and other nuclear anomalies in buccal smears: methods development. Mutat Res 1992;271:69–77. DOI: 10.1016/0165-1161(92)90033-i
Cerqueira EM, Meireles JR, Lopes MA, et al. Genotoxic effects of X-rays on keratinized mucosa cells during panoramic dental radiography. Dentomaxillofac Radiol 2008;37:398–403. DOI: 10.1259/dmfr/56848097
Ingle JI, Bakland LK, Baumgartner JC. Ingle's, Bakland, Baumgartner. Ingles Endodontics, 6th Ed. Endodontic Therapy for Primary Teeth. Hamilton: BC Decker Inc.; 2008. pp. 1400–1430.
Mathewson RJ, Robert E. Radiographic Assessment. In: Primosch. Fundamentals of Pediatric Dentistry, 3rd ed. Carol Stream: Quintessence Books; 1995. pp. 35–55.
Mohan N, Ravikumar PT, Madhumitha C. Genotoxic and cytotoxic effects following dental and panoramic radiography. Indian J Oral Sci 2016;7:92–98. DOI: 10.4103/0970-9371.160559
Ingle JI, Bakland LK, Baumgartner JC. Ingle's Endodontics, 6th ed. Digital Imaging; 2008. pp. 580–589.
Shashikala R, Indira AP, Manjunath GS, et al Role of micronucleus in oral exfoliative cytology. J Pharm Bioallied Sci 2015;7:S409–413. DOI: 10.4103/0975-7406.163472
Manpreet SD, Sonal G, Jatinder B, et al. Micronucleus as a non-invasive biomarker—a review. JAMPS 2016;6:1–9. DOI: 10.9734/JAMPS/2016/24136
Jois HS, Kale AD, Mohan Kumar KP. Micronucleus as potential biomarker of oral carcinogenesis. IJDA 2010;2:197–202. DOI: 10.4103/JOC.JOC_141_17
Neri M, Fucic A, Knudsen LE, Lando C, Merlo F, Bonassi S. Micronuclei frequency in children exposed to environmental mutagens: a review. Mutat Res 2003;544:243–254. DOI: 10.1016/j.mrrev.2003.06.009
Popova L, Kishkilova D, Hadjidekova VB, et al. Micronucleus test in buccal epithelium cells from patients subjected to panoramic radiography. Dentomaxillofac Radiol 2007;36(3):168–171. DOI: 10.1259/dmfr/29193561
Arora P, Devi P, Wazir SS. Evaluation of genotoxicity in patients subjected to panoramic radiography by micronucleus assay on epithelial cells of the oralmucosa. J Dent 2014;11:47–55. pubmed id 24910676.
Vidya KB, Kalappanavar AN, Muniyappa M. Genotoxic effects of panoramic radiation by assessing the frequency of micronuclei formation in exfoliated buccal epithelium. Int J Res Med Sci 2014;2:541–544. DOI: 10.5455/2320-6012.ijrms20140533
Veeracharil U, Venkatesh S, Yadav A, et al. Biomonitoring genetic instability in normal healthy population using a simple cytogenetic marker- micronucleus test. Internat Multidiscipl Res J 2011;1:1–9. corpus ID 82240054
Madhavan R, Kumarswamy M, Kumr SM. Genetic damage in exfoliated cells from oral mucosa of individuals exposed to rays after panoramic radiographs: a cross-sectional Study. J Indian Aca Oral Med Radiol 2012;24:102–105. DOI: http://dx.doi.org/10.1667/RR1560.1
Yoon AJ, Wu HC, Angelopoulos C, et al. Expression of activated checkpoint inase 2 and histone 2AX in exfoliative oral cells after exposure to ionizing radiation. Radiat Res 2009;171:771–775. DOI: http://dx.doi.org/10.1667/RR1560.1
Waingade M, Medikeri RS. Analysis of micronuclei in buccal epithelial cells in patients subjected to panoramic radiography. Indian J Dent Res 2012;23(5):574–578. DOI: 10.4103/0970-9290.107329
Sandhu M, Mohan V, Kumar JS. Evaluation of genotoxic effect of X-rays on oral mucosa during panoramic radiography. J Indian Acad Oral Med Radiol 2015;27:25–27. DOI: 10.4103/0972-1363.167070
Angelieri F, de Oliveira GR, Sannomiya EK, et al. DNA damage and cellular death in oral mucosa cells of children who have undergone panoramic dental radiography. Pediatr Radiol 2007;37:561–565. DOI: 10.1007/s00247-007-0478-1
El-Ashiry E, Abo-Hager E, Gawish A. Genotoxic effects of dental panoramic radiograph in children. J Clin Pediatr Den 2010;35:69–74. DOI: 10.17796/jcpd.35.1.y613824735287307
Lorenzoni DC, Fracalossi ACC, Carlin V, et al. Cytogenetic biomonitoring in children submitting to a complete set of radiographs for orthodontic planning Angle Orthodont 2012;82:585–590. DOI: 10.2319/072311-468.1
Haghgoo R, Sedaghat R, Ahmadvand M, et al. Cytological Changes of oral mucosa following lateral cephalometry and panoramic radiograph. Int J Dent Clin 2014;6:1–3.
Carlin V, Artioli AJ, Matsumoto MA, et al. Biomonitoring of DNA damage and cytotoxicity in individuals exposed to cone beam computed tomography. Dentomaxillofac Radiol 2010;39(5):295–299. DOI: 10.1259/dmfr/17573156
Rosin MP, German J. Evidence for chromosome instability in vivo in Bloom syndrome: increased numbers of micronuclei in exfoliated cells. Hum Genet 1985;71:187–191. DOI: 10.1007/BF00284570
Kamboj M, Mahajan S. Micronucleus - an upcoming marker of genotoxic damage. Clin Oral Invest 2007;11:121–126. DOI: 10.1007/s00784-006-0075-y