Oral health in liver transplant children administered cyclosporin A or tacrolimus

BACKGROUND

Immunosuppression by cyclosporin A (CsA) is associated with adverse side-effects, including nephrotoxicity, neurotoxicity and gingival overgrowth. Tacrolimus (TAC/FK506) is a new immunosuppressive agent, recently approved for use in solid-organ transplants. The mode of action of TAC is similar to that of CsA and the toxicity profile of CsA is duplicated by TAC. The effect of TAC on the gingival tissue is not yet conclusive.

SAMPLE

Gingival overgrowth was assessed in 30 liver transplant children, 20 boys and 10 girls, aged 2-19 years. Seventeen children (10 boys, seven girls) were on a CsA-based immunosuppressive regimen whereas 13 children (10 boys, three girls) were on TAC for at least 1 year (mean 4.3 +/- 2.7).

RESULTS

In the CsA group, 35% of children exhibited gingival overgrowth characterized by one or more units with increased sulcus probing depth (> or = 4 mm), i.e. pseudopockets. In contrast to the CsA group, none of the children in the TAC group exhibited gingival overgrowth. The occurrence of enamel hypoplasia was observed in 11 children (36%) and enamel opacities were found in 23 children (76%). Six of the 12 children (50%) with hyperbilirubinaemia biliary atresia exhibited a marked greenish discoloration of the teeth. Caries experience (dmft/DMFT) among these children was 2.0 +/- 2.8.

CONCLUSION

No difference in caries experience or enamel defect was observed between the CsA and TAC group.

Developmental dental defects in children who reside by a river polluted by dioxins and furans

The authors determined that demarcated hypomineralizations of developing teeth are a biological indicator of an early dioxin exposure in a healthy population of children. In the current study, the authors examined the prevalences of the demarcated hypomineralization lesions of teeth in 2 Finnish towns by the Kymijoki River--a river that is severely contaminated by dioxins and furans. The 4,120 permanent first molars of 1,030 children were studied. The prevailing levels of dioxins and furans in human milk were measured. The prevalences of the defects in children in Kotka and Anjalankoski were 14.2% and 5.6%, respectively, and the corresponding dioxins and furans in human milk were 13.4 pg/gm fat and 10.9 pg/gm fat (International Toxic Equivalents). In Anjalankoski, the duration of total breast-feeding was associated with the prevalence of the defects. Compared with the figures reported earlier in Finland, neither the prevalence of dental lesions nor the levels of dioxins and furans in human milk were increased in riverside residents.

Heavy metal poisoning in glass worker characterised by severe

The paper presents the clinical description of the masticatory organ and biochemical assessment of dental tissue in a patient employed in a glassworks for 20 years. During 12 years the patient has suffered baldness ("Alopecia areata") and atypical extensive and non-healing cutaneous lesions. Dental examination revealed changes typical of chronic poisoning by cadmium and bismuth compounds.

Dental abnormalities in children treated for neuroblastoma

PURPOSE

To determine the frequency and types of dental abnormalities among children treated at a young age for cancer, as represented by neuroblastoma.

PATIENTS AND METHODS

We retrospectively reviewed the dental records and panoramic radiographs of 542 children who were treated for neuroblastoma at our institution over a 31-year period. Patients in our study had to meet the following criteria: they were treated on an institutional protocol, they had undergone panoramic radiography, and their dental follow-up continued for at least 2 years after diagnosis. We evaluated the frequency of clinically or radiographically apparent microdontia, excessive caries, root stunting, hypodontia, and enamel hypoplasia in our study population.

RESULTS

Of the 52 patients who met the study criteria, 71% developed dental abnormalities, comprising microdontia in 38%, excessive caries in 29%, root stunting in 17%, hypodontia in 17%, and enamel hypoplasia in 17%. In nearly half (23) of our patients, neuroblastoma was diagnosed on or before their first birthday.

CONCLUSION

Children treated for neuroblastoma are at high risk for abnormal dental development. The abnormalities in these patients may require extensive dental care and can compromise their quality of life. Frequent dental examinations and an intense oral hygiene program before, during, and after treatment may improve overall dental health.

Cadmium-induced dental lesions in ovariectomized rats

The effects of cadmium chloride on both incisor and molar teeth of ovariectomized female rats were studied histopathologically. The rats were injected intravenously with the compound at doses of 1.0 and 2.0 mg/kg, 5 days/wk. Six rats per group were sacrificed at 4, 8, and 13 wk. Discoloration of the incisors was observed in the rats of the 2.0-mg/kg group from 8 wk. Histopathologic examination of the incisor demonstrated decreased iron-containing pigment in ameloblasts and destruction of the enamel organ. These changes were accompanied with accumulation of cadmium and loss of iron in the teeth. Necrosis of the dental pulp occurred from the coronal end of both the incisor and molar teeth extended to the apical, deep portion of the teeth. The dental pulp of the molar teeth, which is shorter than that of the incisor, was mildly affected by cadmium intoxication. These findings suggested that intradental ischemia due to cadmium toxicity may have contributed to the development of the pulpal necrosis.

Pharmacologic management of patients with diseases of the endocrine system

Endocrine disorders are commonly seen in the general population. This article discusses the physiology, pathogenesis, and the medical and dental management of patients with thyroid, parathyroid, and pituitary gland disorders. In addition, the pharmacologic treatment, common side effects, and dental drug interactions of concern are discussed.

Review article. The rat incisor in toxicologic pathology

Microscopic examination of the incisors of rats and mice may reveal toxicologically significant changes. First, the incisor morphology reflects the nutritional status of the animal: fluctuations of mineral metabolism and vitamin availability are disclosed by the rodent incisors, because the incisors continue to grow during life. Similarly, direct or indirect changes of mineral metabolism by a test substance are reflected in the morphological appearance of the incisor dentin. In addition, hormonal disturbances may give rise to typical structural alterations of the incisor in the test animal. Certain chemicals may have deleterious effects upon the odontogenic tissues, resulting in tooth malformation and malocclusion and eventually in odontomas. Apparent nasal tumors may turn out to be of dental origin. Nasal luminal masses that are discussed within this scope are dental malformation, dental callus, and true odontogenic tumors. According to our experience, odontogenic tumors might possibly develop within the scope of a reaction to mechanical tooth trauma as well. In carcinogenicity studies, this consideration deserves attention when evaluating treatment-related putative odontogenic tumors.

[Impact of antimitotic chemotherapy on the dentition. Apropos of 71 cases]

The authors show the responsibility of antimitotic chemotherapy on the disturbances in dental development in the young children. They insist on doing an odonto-stomatologic check-up at the beginning of the treatment and to keep a constant watch during the treatment and until the end of dental evolution.

Dental properties of antiseptic throat lozenges formulated with sugars or Lycasin

Thirteen different formulations of throat lozenges were examined for their acidity, demineralizing action on hydroxylapatite, and fermentability by human dental plaque micro-organisms. Their flavouring acids gave them low pH values in the range 2.6-3.7, leading to the dissolution of calcium and phosphorus from hydroxylapatite. The combination of antiseptics and flavouring acids in the lozenges inhibited microbial growth and metabolism. In the absence of any antiseptics and flavouring acids, the growth and metabolic activity of cultures of plaque micro-organisms were significantly greater on sucrose+glucose lozenges than on a new Lycasin formulation.

Coronal dentinal nodules induced by single or multiple injections of HEBP in young rats

In the developing tooth, the bisphosphonate HEBP causes hypoplasias and hypomineralization of the enamel and dentine as well as inhibition of acellular cementum formation. Here, we describe a novel effect, associated with dentine mineralization. HEBP was administrated to young rats, and the maxillary molars were analyzed histologically. Localized dentinal nodules, protruding towards the pulp, were found in the developing crown of the molars. They occurred in regions, where the mantle dentine was about to mineralize at the time of the injection, and were more frequent at the mesial cusp side. The nodules accumulated mineral, as evidenced by the fluorescence after calcein and tetracyclin labelling. Histologically, the nodules were separated from the enamel by a layer of mantle dentine and were progressively surrounded by predentine and dentine. The nodules were interpreted to contain transport or metabolism intermediates, which were locally accumulated due to the interruption of the mineralization process by HEBP.

Ankylosis of the mouse molar after systemic administration of 1-hydroxyethylidene-1,1-bisphosphonate (HEBP)

The proposed homeostasis between fibroblasts in the periodontal ligament and bone cells lining the inner aspect of the alveolar wall is thought to be responsible for maintaining the width of the periodontal ligament space. In the present study, we attempted to interfere with this cellular balance by systemic administration of 1-hydroxyethylidene-1,1-bisphosphonate (HEBP). The maxillary left molars of mice were extracted. They then received a daily subcutaneous injection of HEBP (10 mg P/kg b.w.) for periods of 10, 30 or 50 days. A 2nd group of animals received HEBP without molar extraction. Control groups were injected with Ringer's solution. The animals were sacrificed after the last injection and the mandibles processed for light and electron microscopy. HEBP treatment caused a significant decrease of the width of the periodontal ligament space which was influenced by time. Ankylosis started to occur after 30 days, predominantly in the interradicular areas and was more common around unopposed teeth. At 50 days, signs of resorption were seen along the acellular cementum layer. During HEBP-administration, extensive deposition of newly formed cementum matrix was observed along the cellular cementum but this activity was not seen along the acellular cementum. It is concluded that HEBP interferes with the mechanisms that mediate preservation of the periodontal ligament width.

Repair processes in the periodontium following dentoalveolar ankylosis: the effect of masticatory function

It has recently been shown that administration of the drug 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) perturbs the homeostasis in the periodontal ligament resulting in an osteoid-mediated ankylosis between the alveolar wall and the root surface. In the present study, the events after discontinuing HEBP administration were investigated and the effect of function on repair of the periodontal ligament was evaluated. In mice, the maxillary left molars were extracted. They then received a daily subcutaneous injection of HEBP (10 mg P/kg b.w.) for a period of 50 days, were killed 24 h, 14, 28, 56 and 112 days after the last injection and their mandibles processed for light microscopy. HEBP administration caused a significant decrease of the width of the periodontal ligament space with localized ankylosis. In the period after discontinuing HEBP treatment, the newly-formed bone did first mineralize and was then partly resorbed resulting in the disappearance of the ankylotic areas. Furthermore, root resorption was seen. Finally, the periodontal ligament regained its normal architecture and width and a new layer of cementum was formed. Functional teeth showed more root resorption than hypofunctional ones and a more rapid repair of the periodontal ligament. It is concluded that in the period after HEBP treatment the periodontal ligament regains its normal width by a repair process including extensive root resorption, that seems to accelerate this process.

Disturbances in the oral cavity in pediatric long-term survivors after different forms of antineoplastic therapy

Oral health and disturbances in dental development were studied in long-term survivors after antineoplastic therapy. Fifty-seven children treated with combination chemotherapy and 19 children treated with total body irradiation (TBI) prior to bone marrow transplantation (BMT) were examined. The variables studied were dental caries, salivary flow, salivary microbial counts, enamel disturbances, and disturbances in dental development. The results showed no increased caries experience in children treated with BMT or chemotherapy compared with controls. Children treated with BMT had a significantly lower salivary secretion rate of 0.7 +/- 0.4 ml/min, compared with 1.1 +/- 0.5 in the chemotherapy group, and 1.3 +/- 0.6 in the control group (P < 0.05). The clinical examination showed equal numbers of teeth affected by disturbances in enamel mineralization in the BMT and chemotherapy groups. A mean 15.9 +/- 8.2 teeth were affected by disturbances in root development in the BMT group compared with 1.2 +/- 1.6 in the chemotherapy group (P < 0.001). The results show that children who are long-term survivors of pediatric malignant diseases exhibit a wide range of disturbances in the oral cavity. In this study the most severe disturbances are found in children treated with total body irradiation prior to BMT.

Evolution of fluoride concentrations in cattle and grass following a volcanic eruption

This study determined fluoride concentrations of forage, water and bovine serum 2-y after the cessation of a volcanic eruption. Three farms within the polluted area were selected, and water and green grass were collected from April 1990 to February 1992. Samples of hay were collected twice from each farm. Five cows exposed during the 13-mo eruption and 6 young bulls not exposed during the volcanic eruption had blood collected monthly or bimonthly. Serum fluoride concentrations and alkaline phosphatase activities were determined and dental conditions observed in all animals. Grass fluoride remained low except during spring of the second year; high fluoride was in the hay. Serum fluoride of the cows remained near acceptable reference values, although some cows had higher values; serum fluoride of the bulls markedly increased during the spring of the second year. Severe incisor attrition occurred in the cows, while the young bulls had less severely eroded teeth.

[Drug-induced changes in the teeth and mouth. II]

As in the previous paper the unwanted effects of drugs or chemicals in the orofacial region are described. The authors take into consideration alterations such as gingival hyperplasia and hypertrophy, discoloration of the oral mucosa and teeth, oral ulceration and stomatitis, cervical lymphadenopathy, drug induced blood dyscrasias, bleeding caused by aspirin and other drugs, and cleft lip and cleft palate.

Long-term occlusal guidance of a severely intoxicated patient with yusho (PCB poisoning): a case report

The peculiar dentoorofacial characteristics and 12 years of interdisciplinary management of a patient who was severely intoxicated with the man-made chemical polychlorinated biphenyls (PCBs) are described in this case report. Cephalometric measurements showed that the SNA and SNB angles were reduced but that the developments in height and skeletal maturity were in normal ranges. Gingival hyperpigmentation that was caused by high blood PCB concentration was extremely slow to fade. A cystic mass, diffused trabeculae, and irregular calcification, which were shown on the radiograph and which were caused by high blood levels of PCB, changed gradually. However, the patient had periodontal disease because of horizontal alveolar bone resorption and a deep periodontal pocket, despite good plaque control. After the PCB poisoning the tooth roots were hypoplastic and dilacerated. One root was extracted because of chronic periodontitis. Some teeth were impacted, malposed, or ankylosed.

Prevention of dental diseases following radiotherapy and chemotherapy

The general dental practitioner should be aware of the oral changes that take place during chemotherapy and radiotherapy for neoplasms in the head and neck regions. Some of the changes make patients more vulnerable to dental diseases and complications if teeth need to be extracted. Ideally, patients should be made dentally fit before treatment, in order to avoid the risk of extractions later. In the long term, periodontal diseases and caries can be controlled with adequate monitoring and with appropriate use of chlorhexidine and fluoride.

Dentofacial development in long-term survivors of acute lymphoblastic leukemia. A comparison of three treatment modalities

Ninety-seven children who were diagnosed with acute lymphoblastic leukemia before 10 years of age and treated with chemotherapy alone, chemotherapy plus 1800-cGy cranial irradiation (RT), or chemotherapy plus 2400-cGy RT were evaluated for effects of therapy on dentofacial development. All patients were seen at least 5 years postdiagnosis. Dental abnormalities were determined from panoramic radiographs, and craniofacial evaluations were made from lateral cephalometric radiographs. Ninety-one (94%) of all patients and 41 (100%) of patients younger than 5 years of age at diagnosis had abnormal dental development. The severity of these abnormalities was greater in children who received treatment before 5 years of age and in those who received RT. Observed dental abnormalities included tooth agenesis, arrested root development, microdontia, and enamel dysplasias. Craniofacial abnormalities occurred in 18 of 20 (90%) of those patients who received chemotherapy plus 2400-cGy RT before 5 years of age. Mean cephalometric values of this group showed significant deficient mandibular development. The results of this study suggest that the severity of dentofacial-developmental abnormalities secondary to antileukemia therapy are related to the age of the patient at the initiation of treatment and the use of cranial RT.

[Odontostomatological problems in patients with neoplastic pathology treated by chemotherapy. A bibliographic review]

A careful examination of the mouth should be a routine check in patients affected by neoplasms before commencing chemotherapy. This allows an appropriate programme of odontostomatologic treatment to be drawn up and put into practice before, during and after the administration of anti-blastic drugs. Together with instructions for the maintenance of oral hygiene which should be given to the patient, this treatment will reduce the morbidity and mortality which is induced, either directly or indirectly by chemotherapy.

Clinical registration of charge transfer between dental metallic materials in patients with disorders and/or discomfort allegedly caused by corrosion

Thirty referred patients and 15 control subjects were investigated with reference to the occurrence of bimetallic corrosion in the oral cavity. No differences between patients and controls could be found regarding the registered charge transfer between dissimilar short-circuited dental metallic restorations and/or appliances. However, a relatively large number of periodontal and mucous membrane affections, carious lesions and stomatognathic and/or temporomandibular joint disturbances were found within the patient group.

Oral manifestations of systemic chemotherapy and their management

Many antineoplastic drugs in use now have cytotoxic side effects that also manifest in the oral cavity or influence dental management. Chemotherapeutic agents that have a high potential for precipitating oral mucosal damage and bone marrow depression are methotrexate, cyclophosphamide, daunorubicin, doxorubicin hydrochloride, 5-fluorouracil, bleomycin, nitrogen mustard, cytosine-arabinoside, 6-mercaptopurine, busulfan, and L-phenylalanine mustard. Mucositis may lead to neglected oral hygiene, which in turn may cause a chain reaction of local infections, bleeding, and septicemia in myelosuppressed patients. Preventive oral care before chemotherapy and active oral care during therapy are necessary for compromised patients. A protocol for oral care is described.

Tissue reactions to two root canal sealers containing formaldehyde

Tissue reaction to root fillings using either Endomethasone or N2 was investigated in the premolar teeth of dogs. Periapical inflammation was frequently observed, but of greater significance was the universal evidence of ankylosis and the accompanying resorption of teeth filled with N2. One tooth filled with Endomethasone also exhibited this condition. The results of this study do not support the use of these root canal sealers that contain formaldehyde.