Gardner syndrome is a neoplasic disease that associates intestinal polyposis and colorectal adenocarcinoma with osteomas and soft tissue tumors determined by germline mutations in the APC gene. The early diagnosis and identification of high-risk individuals are important because patients have a 100% risk of colon cancer. We present the case of a family with Gardner syndrome. Cephalometric, panoramic X-rays and CBCT of the proband and her brother showed multiple osteomas affecting the skull bones, mandible and paranasal sinuses. The detailed family history showed an autosomal dominant transmission with the presence of the disease in the mother and maternal grandfather of the proband. Both had the typical signs of disease and died in the fourth decade of life. Based on these aspects the clinical diagnosis was Gardner syndrome. By gene sequencing, a novel pathogenic variant c.4609dup (p.Thr1537Asnfs*7) in heterozygous status was identified in the APC gene in both siblings. We reviewed literature data concerning the correlation between the localization of mutations in the APC gene and the extracolonic manifestations of familial adenomatous polyposis as well as their importance in early diagnosis and adequate oncological survey of patients and families based on abnormal genomic variants.

Objectives: Our aim was to demonstrate the occurrence of post-radiotherapy side effects- even in the case of using intensively modulated therapy (IMRT) in patients with ENT cancer as its are: radiomucositis, dental caries, osteoradionecrosis, the increase in the size of the existing periapical lesions before radiotherapy, dysphagia, dysgeusia. Materials and methods: Our study included 35 cancer patients age between 32-81 years old with ENT cancer- neoplasm of larynx, oropharynx, oral cavity, nasopharynx, hypopharynx, sinuses; under treatment at the Regional Institute of Oncology, Iasi. They were examinated by one dental generalist, two endodontist, one radiologist, one doctor specialized in radiotherapy and an ENT doctor before and after radiotherapy. We used as irradiation dose between 50-70 Gy. Results: All patients suffered from various forms of cancer; the majority (40%) presented a neoplasm of the larynx, 8 patients (22,9%) presented a neoplasm of oropharynx, 6 patients (17,1%) presented a neoplasm of the oral cavity. Other forms of neoplasm found were nasopharynx, hypopharynx and respectively sinus neoplasm (1 case). The vast majority of the patients presented radiomucositis grade 2 (34,3%) and 3 (45,7%). The distribution of the localization of periapical lesions changed before and after radiotherapy. Osteoradionecrosis was initially diagnosed in 3 of the 35 patients (8,6%); after radiotherapy osteoradionecrosis was diagnosed in 6 patients (17,1%). We did not identify a statistically significant relationship between the dose of radiation administered and the degree of radiomucositis. Disscusions: Our retrospective study reported a frequency of 40% cancer of the larynx, 22,9% cancer of the oropharynx and 17,1% neoplasm of the oral cavity, followed by cancer of the nasopharynx, hypopharynx and sinus neoplasm out of a total of 35 patients taken into account. Taking into account the fact that the patients received an irradiation dose between 70 Gy (65,7%)- 66 Gy (22,9%), the degree of radiomucositis was mainly 2 (34,3%) or 3 (45,7%). We observed an increase in the diameter of the periapical lesions after radiotherapy associated with the dose of radiation administered. Areas with osteoradionecrosis revealed the same tendency of increase in their comparative analysis after the applied irradiation doses. Conclusions: The management of the side effects of radiotherapy can b

Background and Objectives: The present study aimed to evaluate the association between dental caries, periodontal pockets, and radiologically detected periapical lesions with serum levels of Dickkopf-1 (Dkk-1) and tartrate-resistant acid phosphatase 5 (TRAP-5) in oncological patients with ear, nose, and throat (ENT) cancer compared with healthy controls. Materials and Methods: The study included 63 subjects divided into a study group of 33 patients diagnosed with ENT cancer and a control group of 30 healthy individuals. Blood samples were collected to determine serum Dkk-1 levels using a sandwich enzyme immunoassay and TRAP-5 levels. Dental radiological evaluation consisted of orthopantomography (OPT) and cone-beam computed tomography (CBCT) to assess the number and depth of dental caries and the presence of periapical lesions. Periodontal pockets were recorded through clinical examination. Results: OPT assessment showed a maximum of eight carious sites in both groups. The mean number of carious lesions was higher in healthy subjects (2.97 ± 2.48) than in cancer patients (2.06 ± 2.29). CBCT evaluation revealed 0–8 carious lesions in healthy individuals (maximum = 8) and 0–6 lesions in cancer patients (maximum = 6). The mean number of caries detected by CBCT was significantly higher in the control group (2.97 ± 2.48) compared with the cancer group (1.85 ± 1.89). Periodontal pockets were more frequent in cancer patients (mean: 0.67 ± 1.32) than in controls (0.37 ± 0.81). OPT evaluation showed a higher mean number of periapical lesions in cancer patients (0.82 ± 1.29) compared with controls (0.37 ± 0.67). CBCT examination demonstrated that the mean number of periapical lesions in cancer patients was more than twice that of the control group; however, this difference did not reach statistical significance. Conclusions: Patients with ENT cancer presented a higher prevalence of periodontal pockets and periapical lesions compared with healthy controls, while carious lesions were more frequently detected in healthy individuals. Radiological findings, together with systemic biomarkers such as Dkk-1 and TRAP-5, may contribute to a better understanding of oral–systemic interactions in oncological patients.

Objectives: The aim of this study was to evaluate the variation in the size of periapical lesions in patients with ENT cancer before and after radiotherapy by using the imaging examination represented by CT. Materials and methods: our study included 35 cancer patients-34 men and one female, with ENT cancer, under treatment at the Regional Institute of Oncology, Iasi. They were examinated by four endodontist, two radiologists and an ENT doctor. We measured the size of the periapical lesions before and after radiotherapy. Results: We found the change in the dimensions of periapical lesions: their maximum overall size was initially 5.4591 ± 3.88509 mm; after radiotherapy the global maximum size reached 7.0000 ± 3.37510, reaching 14.00 mm. The observed difference was statistically significant, so it could be stated that radiotherapy accentuates the severity of periapical lesions systematically. Before radiotherapy, the most extensive periapical lesions were observed in the case of laryngeal neoplasm ( with an average of 6.6778 ± 4.17246 mm) and nasopharyngeal neoplasm ( with an average of 6.000 ± 2.82843 mm) and the lowest ones were found in the case of the neoplasm of the oropharynx (with an average of 4.0000 ± 3.74166 mm). After radiotherapy, we found an increase in the size of the periapical lesions in the case of all five types of neoplasm investigated. The most extensive lesions were observed in the case of the neoplasm of the oropharynx, with an average of 7.6000 ± 3.84708 mm, followed by the neoplasm of the larynx, with an average of 7.4000 ± 3.33999 and the neoplasm of the oral cavity, with an average of 7.4000 ± 4.33590 mm. Disscusions: In terms of expectancy and quality of life of patients can only be achieved through a multidisciplinary approach. As soon as the dentist diagnoses a pontetially malignant disorder in the ENT sphere, patients should undergo an ENT screening complete for detecting lesions in any area of the upper aerodigestive tract. After radiotherapy an increase in the size of the periapical lesions is observed. The ENT doctor must encourage the patients with ENT cancer to extract their teeth with periapical lesions before the implementation of radiotherapy to avoid the risk of postradiotherapy osteoradionecrosis. Conclusions: By using CT, the increase in the size of periapical lesions after radiotherapy is observed in patients with cancer in the ENT sphere.

Background and Objectives: This study aimed to evaluate associations between dental caries, periodontal pockets, and radiologically detected periapical lesions in relation to serum levels of Dickkopf-1 (Dkk-1) and tartrate-resistant acid phosphatase 5B (TRAP-5B) in oncologic patients with ear, nose, and throat (ENT) cancer compared with healthy controls. Materials and Methods: The study included 63 subjects divided into a study group of 33 patients diagnosed with ENT cancer and a control group of 30 healthy individuals. Blood samples were collected to assess serum Dkk-1 levels using a sandwich enzyme immunoassay and TRAP-5B levels. Radiological dental evaluation included orthopantomography (OPT) and cone beam computed tomography (CBCT) to assess the number and depth of dental caries and the presence of periapical lesions. Periodontal pockets were recorded through clinical examination. Results: Serum biomarker analysis demonstrated significant differences between groups: TRAP-5B levels were significantly higher in patients with ENT cancer, whereas Dkk-1 concentrations were significantly lower compared with healthy controls (p < 0.001). OPT revealed up to eight carious lesions in both groups. The mean number of carious lesions was higher in healthy subjects (2.97 ± 2.48) than in patients with ENT cancer (2.06 ± 2.29). CBCT evaluation revealed 0–8 carious lesions in healthy individuals and 0–6 lesions in patients with ENT cancer, with a significantly higher mean number of lesions in the control group (2.97 ± 2.48 vs. 1.85 ± 1.89). Periodontal pockets were more frequent in patients with ENT cancer (0.67 ± 1.32) than in controls (0.37 ± 0.81). OPT evaluation also showed a higher mean number of periapical lesions in patients with ENT cancer (0.82 ± 1.29) compared with controls (0.37 ± 0.67). CBCT examination demonstrated that the mean number of periapical lesions in patients with ENT cancer was more than twice that of the control group, although this difference did not reach statistical significance. Conclusions: Patients with ENT cancer exhibited significantly altered systemic bone turnover biomarker profiles, characterized by increased TRAP-5B and decreased Dkk-1 levels. Clinically, these patients also presented a higher prevalence of periodontal pockets and periapical lesions, whereas carious lesions were more frequently detected in healthy individuals. The combined radiological and biochemical findings contribute to a better understanding of oral–systemic interactions in oncologic patients and highlight the importance of comprehensive dental evaluation prior to oncologic therapy.