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Akitomo T, Tsuge Y, Mitsuhata C, Nomura R. A Narrative Review of the Association between Dental Abnormalities and Chemotherapy. J Clin Med 2024; 13:4942. [PMID: 39201084 PMCID: PMC11355227 DOI: 10.3390/jcm13164942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
Dental abnormalities are often detected in childhood and are reported to occur with high prevalence in patients who have undergone cancer treatment or chemotherapy. We performed a literature search of PubMed from 2004 to 2024 using the terms "dental anomaly" and "panoramic examination", and 298 potentially relevant articles were found. Thirty-one articles about dental abnormalities matched the eligibility criteria and were extracted for this review. Although the prevalence of tooth agenesis and microdontia in the general population was reported to be approximately 10% and 3%, respectively, the prevalence in patients who had undergone cancer treatment or chemotherapy was higher in all surveys, suggesting that the treatment is related to the occurrence of dental abnormalities. It is important to continue long-term follow-up with patients not only during treatment but also after the completion of treatment. Dental professionals should provide information about dental abnormalities to patients, their guardians, and medical professionals, which may lead to improvement in the quality of life of patients.
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Milgrom SA, van Luijk P, Pino R, Ronckers CM, Kremer LC, Gidley PW, Grosshans DR, Laskar S, Okcu MF, Constine LS, Paulino AC. Salivary and Dental Complications in Childhood Cancer Survivors Treated With Radiation Therapy to the Head and Neck: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:467-481. [PMID: 34074567 DOI: 10.1016/j.ijrobp.2021.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/14/2021] [Accepted: 04/21/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Radiation therapy (RT) to the head and neck (H&N) region is critical in the management of various pediatric malignancies; however, it may result in late toxicity. This comprehensive review from the Pediatric Normal Tissue Effects in the Clinic (PENTEC) initiative focused on salivary dysfunction and dental abnormalities in survivors who received RT to the H&N region as children. MATERIALS & METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. RESULTS Of the 2,164 articles identified through a literature search, 40 were included in a qualitative synthesis and 3 were included in a quantitative synthesis. The dose-toxicity data regarding salivary function demonstrate that a mean parotid dose of 35 to 40 Gy is associated with a risk of acute and chronic grade ≥2 xerostomia of approximately 32% and 13% to 32%, respectively, in patients treated with chemo-radiation therapy. This risk increases with parotid dose; however, rates of xerostomia after lower dose exposure have not been reported. Dental developmental abnormalities are common after RT to the oral cavity. Risk factors include higher radiation dose to the developing teeth and younger age at RT. CONCLUSIONS This PENTEC task force considers adoption of salivary gland dose constraints from the adult experience to be a reasonable strategy until more data specific to children become available; thus, we recommend limiting the parotid mean dose to ≤26 Gy. The minimum toxic dose for dental developmental abnormalities is unknown, suggesting that the dose to the teeth should be kept as low as possible particularly in younger patients, with special effort to keep doses <20 Gy in patients <4 years old.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - Peter van Luijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ramiro Pino
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas
| | - Cecile M Ronckers
- Princess Máxima Centrum for Pediatric Oncology, Utrecht, Netherlands; Institute of Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany
| | - Leontien C Kremer
- Institute of Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany; UMC Amsterdam, Location AMC, Department of Pediatrics, Amsterdam, Netherlands
| | - Paul W Gidley
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - David R Grosshans
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Siddhartha Laskar
- Department of Radiation Oncgqtology, Tata Memorial Hospital, Mumbai, India
| | - M Fatih Okcu
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Arnold C Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
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De Almeida HCR, Rodrigues CD, De Azevedo LPM, Rosenblatt A, Da Silveira MMF, Sobral APV. Bone age and dental late effects in childhood cancer survivors: Radiographic findings in a Brazilian sample. Int J Paediatr Dent 2024. [PMID: 38711227 DOI: 10.1111/ipd.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/22/2023] [Accepted: 04/14/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Changes in bone age and tooth development are late side effects of cancer therapy and can be identified by imaging examination. AIM To evaluate the late effects of antineoplastic treatment on bone age and dental development in childhood cancer survivors. DESIGN This is a retrospective case-control study on paediatric cancer survivors of both sexes who underwent antineoplastic treatment with 5-15 years of survival. Carpal radiographs were assessed for bone age and growth curve, and panoramic radiographs were used to evaluate dental development and alterations. Carpal radiographs were analyzed using the Greulich and Pyle inspection method, and the Martins and Sakima method was used to analyze the growth curve. All tests were applied with a confidence level of 95%. RESULTS The study and control groups comprised 28 and 56 patients, respectively. There was no significant difference in bone age and growth curve between the study and control groups. Nonetheless, when sex was compared to chronological and bone ages, there was a significant difference in bone age (p = 0.019) and an underestimation in both groups and sexes in the Greulich and Pyle method. As to late dental effects, dental agenesia, microdontia, gyroversion, and unerupted teeth were found. Dental shape alterations mainly involve the root region. CONCLUSION Close multidisciplinary collaboration is necessary during the follow-up period of young patients who have survived cancer.
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Affiliation(s)
| | - Cleomar Donizeth Rodrigues
- Division of Dental Radiology and Imaging, Integrated Colleges of the Educational Union of the Central Plateau, Brasília, Brazil
| | | | - Aronita Rosenblatt
- Department of Pediatric Dentistry, Faculty of Dentistry, University of Pernambuco, Recife, Brazil
| | | | - Ana Paula Veras Sobral
- Division of Oral Pathology, Faculty of Dentistry, University of Pernambuco, Recife, Brazil
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Rotz SJ, Bhatt NS, Hamilton BK, Duncan C, Aljurf M, Atsuta Y, Beebe K, Buchbinder D, Burkhard P, Carpenter PA, Chaudhri N, Elemary M, Elsawy M, Guilcher GM, Hamad N, Karduss A, Peric Z, Purtill D, Rizzo D, Rodrigues M, Ostriz MBR, Salooja N, Schoemans H, Seber A, Sharma A, Srivastava A, Stewart SK, Baker KS, Majhail NS, Phelan R. International Recommendations for Screening and Preventative Practices for Long-Term Survivors of Transplantation and Cellular Therapy: A 2023 Update. Transplant Cell Ther 2024; 30:349-385. [PMID: 38413247 PMCID: PMC11181337 DOI: 10.1016/j.jtct.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 02/29/2024]
Abstract
As hematopoietic cell transplantation (HCT) and cellular therapy expand to new indications and international access improves, the number of HCTs performed annually continues to rise. Parallel improvements in HCT techniques and supportive care entails more patients surviving long term, creating further emphasis on survivorship needs. Survivors are at risk for developing late complications secondary to pretransplantation, peritransplantation, and post-transplantation exposures and other underlying risk factors. Guidelines for screening and preventive practices for HCT survivors were originally published in 2006 and then updated in 2012. An international group of experts was convened to review the contemporary literature and update the recommendations while considering the changing practices of HCT and cellular therapy. This review provides updated pediatric and adult survivorship guidelines for HCT and cellular therapy. The contributory role of chronic graft-versus-host disease (cGVHD) to the development of late effects is discussed, but cGVHD management is not covered in detail. These guidelines emphasize the special needs of patients with distinct underlying HCT indications or comorbidities (eg, hemoglobinopathies, older adults) but do not replace more detailed group-, disease-, or condition-specific guidelines. Although these recommendations should be applicable to the vast majority of HCT recipients, resource constraints may limit their implementation in some settings.
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Affiliation(s)
- Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Blood and Marrow Transplant Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Neel S Bhatt
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Christine Duncan
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Harvard University, Boston, Massachusetts
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Yoshiko Atsuta
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan
| | - Kristen Beebe
- Phoenix Children's Hospital and Mayo Clinic Arizona, Phoenix, Arizona
| | - David Buchbinder
- Division of Hematology, Children's Hospital of Orange County, Orange, California
| | | | | | - Naeem Chaudhri
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mohamed Elemary
- Hematology and BMT, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mahmoud Elsawy
- Division of Hematology, Dalhousie University, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Gregory Mt Guilcher
- Section of Pediatric Oncology/Transplant and Cellular Therapy, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, St Vincent's Clinical School Sydney, University of New South Wales, School of Medicine Sydney, University of Notre Dame Australia, Australia
| | - Amado Karduss
- Bone Marrow Transplant Program, Clinica las Americas, Medellin, Colombia
| | - Zinaida Peric
- BMT Unit, Department of Hematology, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Duncan Purtill
- Fiona Stanley Hospital, Murdoch, PathWest Laboratory Medicine WA, Australia
| | - Douglas Rizzo
- Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Maria Belén Rosales Ostriz
- Division of hematology and bone marrow transplantation, Instituto de trasplante y alta complejidad (ITAC), Buenos Aires, Argentina
| | - Nina Salooja
- Centre for Haematology, Imperial College London, London, United Kingdom
| | - Helene Schoemans
- Department of Hematology, University Hospitals Leuven, Department of Public Health and Primary Care, ACCENT VV, KU Leuven, University of Leuven, Leuven, Belgium
| | | | - Akshay Sharma
- Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, India
| | | | | | - Navneet S Majhail
- Sarah Cannon Transplant and Cellular Therapy Network, Nashville, Tennessee
| | - Rachel Phelan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Al-Ansari S, Stolze J, Bresters D, Brook AH, Laheij AMGA, Brand HS, Dahllöf G, Rozema FR, Raber-Durlacher JE. Late Complications in Long-Term Childhood Cancer Survivors: What the Oral Health Professional Needs to Know. Dent J (Basel) 2024; 12:17. [PMID: 38275678 PMCID: PMC10813876 DOI: 10.3390/dj12010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
With diagnostic and therapeutic advances, over 80% of children diagnosed with cancer become long-term survivors. As the number of childhood cancer survivors (CCS) continues to increase, dental practitioners become more likely to have CCS among their patients. CCS may develop late complications from damage caused by their cancer treatment to endocrine, cardiovascular, musculoskeletal, and other organ systems. These complications may surface decades after the completion of treatment. Adverse outcomes of childhood cancer treatment frequently involve oral and craniofacial structures including the dentition. Tooth development, salivary gland function, craniofacial growth, and temporomandibular joint function may be disturbed, increasing oral health risks in these individuals. Moreover, CCS are at risk of developing subsequent malignancies, which may manifest in or near the oral cavity. It is important that dental practitioners are aware of the childhood cancer history of their patients and have knowledge of potential late complications. Therefore, this narrative review aims to inform dental practitioners of late oral complications of cancer treatment modalities commonly used in pediatric oncology. Furthermore, selected common non-oral late sequelae of cancer therapy that could have an impact on oral health and on delivering dental care will be discussed.
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Affiliation(s)
- Sali Al-Ansari
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands; (S.A.-A.); (A.M.G.A.L.)
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Department Maxillofacial Surgery, Fachklinik Horneide, 48157 Münster, Germany
| | - Juliette Stolze
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands; (J.S.); (H.S.B.)
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
- Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
| | - Alan Henry Brook
- Adelaide Dental School, University of Adelaide, Adelaide 5005, Australia;
- Institute of Dentistry, Queen Mary University of London, London E12AD, UK
| | - Alexa M. G. A. Laheij
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands; (S.A.-A.); (A.M.G.A.L.)
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Henk S. Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands; (J.S.); (H.S.B.)
| | - Göran Dahllöf
- Division of Orthodontics and Pediatric Dentistry, Karolinska Institutet, 14152 Huddinge, Sweden;
- Center for Oral Health Services and Research, Mid-Norway (TkMidt), 100098 Trondheim, Norway
| | - Frederik R. Rozema
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands; (S.A.-A.); (A.M.G.A.L.)
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Judith E. Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands; (S.A.-A.); (A.M.G.A.L.)
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1081 HZ Amsterdam, The Netherlands
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6
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Liu Y, Yang J, Li X, Chen S, Zhu C, Shi Y, Dang S, Zhang W, Li W. Pan-cancer analysis reveals the characteristics and roles of tooth agenesis mutant genes. Medicine (Baltimore) 2023; 102:e36001. [PMID: 38115305 PMCID: PMC10727548 DOI: 10.1097/md.0000000000036001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 12/21/2023] Open
Abstract
Tooth development is regulated by numerous genes and signaling pathways. Some studies suggest that mutations in these genes may be associated with several cancer types. However, the tooth agenesis mutated genes role in the prognosis and their clinical therapeutic potentials in pan-cancer have not been elaborately explored. Moreover, the intrinsic correlation between tooth agenesis and cancers also needs to be further verified. We preliminarily analyzed expression levels and prognostic values of causative genes of tooth agenesis, and explored the correlation between the expression of tooth agenesis mutated genes and TME, Stemness score, clinical characteristic, immune subtype, and drug sensitivity in pan-cancer, which based on updated public databases and integrated some bioinformatics analysis methods. In addition, we conducted the enrichment analysis of tooth agenesis mutant genes from KOBAS database. We observed that TA mutant genes had significant gene expression differences in multiple cancer types compared with normal tissues. The expression of causative genes of TA is associated with the prognosis in several cancers from different databases. For example, AXIN2 and MSX1 were correlated to the overall survival (OS) of uterine corpus endometrial carcinoma. PAX9 and TP63 were related to OS of lung squamous cell carcinoma. And TP63 was associated with OS in breast invasive carcinoma and pancreatic adenocarcinoma. Furthermore, the expression of TA mutant genes also has a significant correlation with stromal and immune scores, and RNA stemness score and DNA stemness score in pan-cancer. Besides, we observed that all causative genes of TA were significantly correlated with immune subtypes. Moreover, KEGG pathway analysis showed that causative genes of TA were associated with the development and progression of breast cancer, basal cell carcinoma, gastric cancer, and hepatocellular carcinoma. Finally, AXIN2 expression has a significantly positive or negative correlation with drug sensitivity. Our study indicates the great potential of TA mutant genes as biomarkers for prognosis and provides valuable strategies for further investigation of TA mutant genes as potential therapeutic targets in cancers. Our study can further verify that there may be an intrinsic correlation between tooth agenesis and the occurrence of multiple cancers.
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Affiliation(s)
- Yating Liu
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jie Yang
- Department of Pediatric Dentistry, Peking University School of Stomatology, Beijing, China
| | - Xinyu Li
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shanshan Chen
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Changyu Zhu
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yijun Shi
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shoutao Dang
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Weitao Zhang
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Cancer Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Jodłowska A, Postek-Stefańska L. Tooth Abnormalities and Their Age-Dependent Occurrence in Leukemia Survivors. Cancers (Basel) 2023; 15:5420. [PMID: 38001680 PMCID: PMC10670488 DOI: 10.3390/cancers15225420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
The multidrug nature of anticancer treatment and different treatment protocols used in the studies are likely to be a major limitation in establishing real risk factors determining the occurrence of dental abnormalities. The authors aimed to establish a relationship between the duration and the dose of chemotherapy and the number of tooth adverse effects in the group receiving the same treatment. Of the 40 anticancer therapy recipients who attended the outpatient dental clinic, 7 leukemia survivors receiving the treatment according to the ALL IC-BFM 2002 protocol were selected. The study group consisted of four females and three males aged 92 to 207 months at the time of dental examination and 29 to 91 months at leukemia diagnosis. As a result of the clinical and radiological examination, dental abnormalities such as agenesis, tooth size reduction, root abnormalities, and taurodontia were identified, and the medical records of all survivors were reviewed in terms of drugs administered, their doses, and treatment schedules. No correlation was observed between the treatment duration of an intensive therapy, the entire therapy, and the number of tooth abnormalities. No relationship was also found between the number of dental abnormalities and the cumulative dose of vincristine, L-asparaginase, methotrexate, cyclophosphamide, cytarabine, and 6-mercaptopurine. The age at the onset of antineoplastic therapy is likely to be the strongest risk factor for toxic injury during tooth development.
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Affiliation(s)
- Anna Jodłowska
- Department of Pediatric Dentistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
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Torlińska-Walkowiak N, Majewska KA, Sowińska A, Kędzia A, Opydo-Szymaczek J. Developmental enamel defects and dental anomalies of number and size in children with growth hormone deficiency. Sci Rep 2023; 13:14707. [PMID: 37679467 PMCID: PMC10484903 DOI: 10.1038/s41598-023-41892-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023] Open
Abstract
Growth hormone is meaningfully involved in the processes of tooth cells differentiation and tissue formation. The aim of the study was to evaluate the occurrence of dental anomalies: microdontia, macrodontia, hypodontia and developmental defects of enamel (DDE) amongst a group of isolated growth hormone deficient (GHD) patients and healthy children. This cross-sectional study was based on a group of 101 Caucasian children: 33 with GHD (mean age 10.94, SD 2.51) and 68 being healthy, normal height subjects (mean age 10.4, SD 2.38). The dental examination in primary and permanent teeth was carried out by one trained and calibrated dentist, in accordance with the WHO guidelines. It was observed that 33% of GHD patients suffer from dental anomalies (hypodontia, microdontia or macrodontia), the difference between the study group and the control group was statistically significant (33% vs 4%, p < 0.001). Hypodontia and microdontia/macrodontia were the most common problems affecting 18% and 21% of the GHD individuals, respectively. The prevalence of DDE did not differ significantly between GHD group and the control group (58% vs 48%, p > 0.05). As children with GHD present more dental anomalies than their healthy coevals, clinicians should be aware of the possible oral health problems associated with GHD and consider dental screening and management as part of the patient's overall health care plan.
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Affiliation(s)
- Natalia Torlińska-Walkowiak
- Department of Pediatric Dentistry, Poznan University of Medical Sciences, 70 Bukowska Street, 60-812, Poznan, Poland.
| | - Katarzyna A Majewska
- Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572, Poznan, Poland
| | - Anna Sowińska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-806, Poznan, Poland
| | - Andrzej Kędzia
- Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572, Poznan, Poland
| | - Justyna Opydo-Szymaczek
- Department of Pediatric Dentistry, Poznan University of Medical Sciences, 70 Bukowska Street, 60-812, Poznan, Poland
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Ozono S, Sakashita K, Yoshida N, Kakuda H, Watanabe K, Maeda M, Ishida Y, Manabe A, Taga T, Muramatsu H. A nationwide survey of late effects in survivors of juvenile myelomonocytic leukemia in Japan. Pediatr Blood Cancer 2023; 70:e30126. [PMID: 36495260 DOI: 10.1002/pbc.30126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
Abstract
We conducted a cross-sectional study using a questionnaire to explore the late effects in survivors of allogenic hematopoietic stem cell transplantation (HSCT) for juvenile myelomonocytic leukemia (JMML). The attending pediatric hematologists/oncologists completed the questionnaires. Of the 30 survivors, approximately 83% showed more than one late effect. The identified late effects included endocrine, dental, skin, ophthalmologic, musculoskeletal, pulmonary, neurocognitive, and cardiovascular dysfunction. The prevalence of short stature, pulmonary, cardiovascular, and nephrological complications was significantly elevated among survivors who were 12 years or more lapsed after HSCT. Therefore, a multidisciplinary follow-up system for survivors of JMML is crucial.
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Affiliation(s)
- Shuichi Ozono
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
- Japan Children's Cancer Group (JCCG), Tokyo, Japan
| | - Kazuo Sakashita
- Japan Children's Cancer Group (JCCG), Tokyo, Japan
- Department of Hemato-Oncology, Nagano Prefectural Children's Hospital, Nagano, Japan
| | - Nao Yoshida
- Japan Children's Cancer Group (JCCG), Tokyo, Japan
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Harumi Kakuda
- Japan Children's Cancer Group (JCCG), Tokyo, Japan
- Department of Hemato-Oncology, Chiba Prefectural Children's Hospital, Chiba, Japan
| | - Kenichiro Watanabe
- Japan Children's Cancer Group (JCCG), Tokyo, Japan
- Department of Hemato-Oncology, Shizuoka Prefectural Children's Hospital, Shizuoka, Japan
| | - Miho Maeda
- Japan Children's Cancer Group (JCCG), Tokyo, Japan
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Yasushi Ishida
- Japan Children's Cancer Group (JCCG), Tokyo, Japan
- Department of Pediatrics, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Atsushi Manabe
- Japan Children's Cancer Group (JCCG), Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Takashi Taga
- Japan Children's Cancer Group (JCCG), Tokyo, Japan
- Department of Pediatrics, Shiga Medical College, School of Medicine, Shiga, Japan
| | - Hideki Muramatsu
- Japan Children's Cancer Group (JCCG), Tokyo, Japan
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Rahul M, Atif M, Ganguly S, Pushpam D, Tewari N, Mathur V, Bakhshi S. Long-term effects of chemotherapy and radiation received during early childhood on the developing dentition of pediatric cancer patients. SPECIAL CARE IN DENTISTRY 2023; 43:87-93. [PMID: 35605233 DOI: 10.1111/scd.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The short-term effects of chemotherapy and irradiation are well documented; however, there is paucity regarding their long-term effects, especially in children and adolescents. CASE DESCRIPTION This paper discusses the long-term effects of chemotherapy and/or radiation received by the patients during their early childhood on the developing dentition. It comprises the compilation of 11 cases with alteration in the dental development screened from 138 cases of the childhood cancer patients who received the chemotherapy and/or radiation as a part of anticancer therapy. RESULTS AND CONCLUSION The findings revealed that the age of initiation of anticancer therapy along with the synergistic effect of chemo-irradiation, and the dose of radiation used were the principal determinants for the dental abnormalities. The root-related abnormalities were found to be varied and more common as compared to the missing teeth and defects related to the tooth crown.
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Affiliation(s)
- Morankar Rahul
- Division of Pediatric & Preventive Dentistry, Centre for Dental Education & Research, All India Institute of Medical Sciences , New Delhi, India
| | - Mohammad Atif
- Division of Pediatric & Preventive Dentistry, Centre for Dental Education & Research, All India Institute of Medical Sciences , New Delhi, India
| | | | - Deepam Pushpam
- Department of Medical Oncology, Dr. B.R.A. IRCH, AIIMS, New Delhi
| | - Nitesh Tewari
- Division of Pediatric & Preventive Dentistry, Centre for Dental Education & Research, All India Institute of Medical Sciences , New Delhi, India
| | - Vijay Mathur
- Division of Pediatric & Preventive Dentistry, Centre for Dental Education & Research, All India Institute of Medical Sciences , New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. IRCH, AIIMS, New Delhi
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Kim J, Lim HJ, Ku JH, Kook YA, Chung NG, Kim Y. Dental developmental complications in pediatric hematopoietic stem cell transplantation patients: A study using CMC clinical data warehouse. PLoS One 2022; 17:e0279579. [PMID: 36548286 PMCID: PMC9778628 DOI: 10.1371/journal.pone.0279579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the prevalence and extent of dental developmental complications in patients who have undergone pediatric hematopoietic stem cell transplantation (SCT) and identify the risk factors. MATERIALS AND METHODS We retrospectively investigated the clinical data warehouse of the Catholic Medical Center information system for identifying patients who: 1) visited the Department of Pediatrics between 2009 and 2019, 2) underwent SCT under the age of 10, and 3) had panoramic radiographs. Thus 153 patients were included in this study. The prevalence and extent of tooth agenesis, microdontia, and root malformation were assessed using panoramic radiographs obtained after SCT, and the risk factors were analyzed using regression analysis. RESULTS All 153 patients had at least one dental anomaly. When grouped according to the age at initial chemotherapy (≤ 2.5; 2.6-5.0; 5.1-7.5; > 7.5 years), the prevalence of agenesis showed statistically significant differences among the different age groups (P < 0.001). The prevalence of agenesis was highest in the youngest age group. As the initial age at chemotherapy increased, the number of affected teeth per patient decreased for all three anomalies. The location of the affected tooth was also influenced by the age at initial chemotherapy. Regression analysis demonstrated that young age at initial chemotherapy was a risk-increasing factor for tooth agenesis and microdontia. CONCLUSIONS The age at initial chemotherapy may be a critical factor in determining the type, extent, and location of dental complications after SCT. These results suggest that careful dental follow-up and timely treatment are recommended for pediatric patients undergoing SCT.
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Affiliation(s)
- Jaehyun Kim
- Department of Orthodontics, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Jin Lim
- Department of Orthodontics, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ja Hyeong Ku
- Department of Orthodontics, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Ah Kook
- Department of Orthodontics, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoonji Kim
- Department of Orthodontics, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail: ,
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Zulijani A, Žigante M, Morelato L, Perić B, Milardović A. Oligomicrodontia in a Pediatric Cancer Survivor after Chemotherapy: A Case Report. Healthcare (Basel) 2022; 10:1521. [PMID: 36011178 PMCID: PMC9408680 DOI: 10.3390/healthcare10081521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Chemotherapy used on pediatric patients especially those below 3 years of age causes disturbances in dental development. The aim of this case report was to present the late dental effects of chemotherapy in a patient treated for anaplastic ependymoma (WHO III) at an early age. Radiographic findings at the age of 9 years showed oligomicrodontia of six teeth, maxillary lateral incisors, and maxillary and mandibular first premolars. Pediatric cancer survivors after chemotherapy have an increased risk of one or more dental development disorders. To ensure proper dental care and to assess the long-term effects on oral health, tooth development, and occlusion, the involvement of a dentist is crucial. Adequate diagnosis and well-planned treatment of the dental defect can significantly improve patient oral health-related quality of life.
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Affiliation(s)
- Ana Zulijani
- Department of Oral Surgery, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Martina Žigante
- Department of Orthodontics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Luka Morelato
- Department of Oral Surgery, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Department of Oral Surgery, Faculty of Dental Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Berislav Perić
- Department of Oral and Maxillofacial Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ana Milardović
- Pediatric Intensive Care Unit, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
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Talekar AL, Musale PK, Kothare SS. Dental Caries and Dental Anomalies in Children Undergoing Chemotherapy for Malignant Diseases. Int J Clin Pediatr Dent 2022; 15:428-432. [PMID: 36875976 PMCID: PMC9983583 DOI: 10.5005/jp-journals-10005-2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose The study aims to evaluate the prevalence of dental caries and anomalies in pediatric patients undergoing chemotherapy or those who have completed chemotherapy. Methods A total of 250 pediatric patients within the age group of 6 months to 17 years, either admitted to hospitals for chemotherapy or on follow-up, were included as a part of the study. Complete oral examination inclusive of the diet history, oral hygiene methods, past dental history, the decayed, missing, and filled teeth (DMFT), def score, and any dental anomaly was diagnosed clinically and radiographically using an orthopantomogram. The samples were further categorized under type of malignancies and duration of chemotherapeutic drug usage groups (from 6 months to 10 years and more than 10 years) to establish a correlation of these variables with the prevalence of dental caries and dental anomalies. Results Among all patients, 108 (43.2%) had completed the treatment (chemotherapy), while 142 (56.8%) were undergoing the treatment. Forty-three (17.2%) patients showed positive findings for dental anomalies. Conclusion The present study confirms the strong positive correlation between long-term exposure to chemotherapeutic agents and the prevalence of dental anomalies and dental caries in children. How to cite this article Talekar AL, Musale PK, Kothare SS. Dental Caries and Dental Anomalies in Children Undergoing Chemotherapy for Malignant Diseases. Int J Clin Pediatr Dent 2022;15(4):428-432.
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Affiliation(s)
- Abhinav Liladhar Talekar
- Department of Pediatric and Preventive Dentistry, M. A. Rangoonwala College of Dental Sciences & Research Centre, Pune, Maharashtra, India
| | - Prasad K Musale
- Department of Pediatric and Preventive Dentistry, M. A. Rangoonwala College of Dental Sciences & Research Centre, Pune, Maharashtra, India
| | - Sneha Sunil Kothare
- Department of Pediatric and Preventive Dentistry, M. A. Rangoonwala College of Dental Sciences & Research Centre, Pune, Maharashtra, India
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Jodłowska A, Postek-Stefańska L. Systemic Anticancer Therapy Details and Dental Adverse Effects in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116936. [PMID: 35682521 PMCID: PMC9180850 DOI: 10.3390/ijerph19116936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 12/05/2022]
Abstract
An idea of therapy intensification in order to make anticancer treatment more effective is still being investigated. The study aimed to estimate the impact of the chemotherapy dose levels and treatment duration on the risk for dental development disturbance. The clinical examination and OPG analysis were carried out in 37 cancer survivors and germ agenesis, microdontia, size reduction, taurodontism, root and enamel abnormalities were identified. An analysis of anticancer treatment was carried out separately for vincristine (VCR), doxorubicin (DXR), cyclophosphamide (CP), etoposide (VP-16), carboplatin (CBDCA) and actinomycin D (ACTD) recipients in terms of treatment duration and drug doses administered. Individuals aged between three years and ten months, and seven years and four months, at diagnosis presented with no severe dental abnormalities, regardless of treatment duration and increasing cytotoxic drug doses. The largest number of abnormalities per one person was noted in the survivors treated with the highest single doses of VCR, DXR, CP and ACTD. No similar observation was made in the cases of cumulative and weekly doses analyzed. Moreover, there were no significant differences between the mean number of abnormalities across all the drug groups.
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15
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Long-Term Effect of Anticancer Therapy on Dentition in Childhood Cancer Survivors: An Observational, Cross-Sectional Study. Indian J Pediatr 2022; 89:327-332. [PMID: 34106443 DOI: 10.1007/s12098-021-03818-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the presence of developmental dental anomalies, like microdontia, hypodontia, abnormally shaped teeth (AST), and developmental defects of enamel (DDE) in childhood cancer survivors and compare it with the healthy controls. METHODS This cross-sectional analytical study was conducted in 2 groups: childhood cancer survivors (CCS) group including children (> 12 y, m/f) who had undergone anticancer therapy (ACT) before 8 y of age and healthy control group (> 12 y, m/f) without any systemic disease. Pearson chi-square test was used to analyze the difference between the CCS group and the control group for microdontia, hypodontia, AST, DDE and for intragroup analysis in CCS group. Odds ratio was also calculated. RESULTS A total of 120 and 121 children were included in CCS and control group, respectively. The prevalence of microdontia, hypodontia, abnormally shaped teeth, and DDE was 17.5% (21), 5% (6), 8.33% (10), and 37.5% (45), respectively in CCS group. It was 8.2% (10), 2.5% (3), 1.65% (2), and 22.3% (27), respectively in the control group. A statistically significant difference was seen in microdontia (p = 0.032), abnormally shaped teeth (p = 0.017) and DDE (p = 0.01). Higher prevalence was seen when ACT began at an early age. CONCLUSION An association between developmental dental anomalies and anticancer therapy (ACT) exists with significantly higher difference in microdontia, abnormally shaped teeth and DDE among survivors of childhood cancer as compared to healthy population. These known adverse effects of ACT on developing teeth should be considered during treatment planning of the children having cancers.
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The prevalence of dental developmental anomalies among childhood cancer survivors according to types of anticancer treatment. Sci Rep 2022; 12:4485. [PMID: 35296697 PMCID: PMC8927608 DOI: 10.1038/s41598-022-08266-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/02/2022] [Indexed: 11/08/2022] Open
Abstract
Survival following childhood cancer has increased considerably. In an observational cross-sectional study, we assessed the prevalence of dental developmental anomalies (DDA) among childhood cancer survivors according to types of anticancer treatment. Permanent teeth were examined clinically and radiographically in 121 adolescents with a history of childhood malignancies, to identify DDA, namely hypomineralization or hypoplasia, microdontia, root changes and hypodontia. DDA were observed in 56/121 individuals (46%), in 309/3388 teeth (9%). Hypomineralization or hypoplasia of enamel appeared in 21 (17%) patients. Altered root development appeared in 26 patients and hypodontia affected 13 (10%). Dental anomalies were observed in 36 (43%) individuals who received chemotherapy and not radiation, in 20 (52%) who received radiotherapy, and in 15 (60%) of those who received head and neck radiotherapy. Among patients who received only chemotherapy, young age (6 years or younger) was associated with a higher number of malformed teeth. In conclusion, antineoplastic treatment that combines chemotherapy and radiotherapy appears to increase the risk of DDA. Radiation to the head and neck area was shown to particularly increase the risk of DDA. No specific chemotherapy agent was found to be associated more than the others with DDA.
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Oral and dental late effects in long-term survivors of childhood embryonal brain tumors. Support Care Cancer 2022; 30:10233-10241. [PMID: 36307656 PMCID: PMC9715513 DOI: 10.1007/s00520-022-07405-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/10/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE To investigate oral and dental late effects in survivors of childhood brain tumors medulloblastoma (MB) and central nervous system supratentorial primitive neuroectodermal tumor (CNS-PNET). METHODS This cross-sectional study assessed oral and dental late effects in MB/CNS-PNET survivors treated before 20 years of age, and with a minimum of 2 years since treatment. Participants went through an oral and radiographic examination. We assessed oral status using the decayed-missing-filled index (DMFT), oral dryness, maximum mouth opening (MMO), fungal infection, and registration of dental developmental disturbances (DDD) in the form of hypodontia, microdontia, and enamel hypoplasia. RESULTS The 46 participants' mean age at enrolment was 27 ± 12.8 years and at treatment 8.5 ± 5.2 years, and the mean time since treatment was 18.9 ± 12 years. Over a third (35%) of survivors had reduced mouth opening (mean 29.3 ± 5.6 mm (range 16-35)). A significantly lower MMO was found in individuals treated ≤ 5 years compared to survivors treated > 5 years (p = 0.021). One or more DDD were registered in 30.4% of the survivors, with a significantly higher prevalence in individuals treated ≤ 5 years (p < 0.001). Hypodontia was the most prevalent type of DDD. There was no difference in DMFT score in relation to age at treatment. Oral dryness was not frequently reported or observed in these survivors. CONCLUSION Survivors of childhood MB/CNS-PNET are at risk of oral and dental late effects including reduced mouth opening and DDD. The risk is highest in survivors treated before the age of 5.
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A Long-Term Follow-Up of Dental and Craniofacial Disturbances after Cancer Therapy in a Pediatric Rhabdomyosarcoma Patient: Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212158. [PMID: 34831922 PMCID: PMC8621981 DOI: 10.3390/ijerph182212158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents. A boy aged seven years and five months was diagnosed with stage three group III embryonal parameningeal RMS with intracranial extension. He received chemotherapy for 23 weeks in combination with localized radiotherapy during the inductive phase of nine weeks (a total tumor dose of 5040 cGy). Three months later, he was referred to the department of pediatric dentistry for radiation-induced caries, the treatment of which was later terminated because of severe trismus and radiation-induced oropharyngeal mucositis. Three years later, the patient returned for the fitting of a prosthesis because of mastication problems. The dental treatments performed included: extraction, banding, composite resin restorations, root canal fillings, and stainless steel crown fabrication. An interim denture was fitted due to the poor retention of the fixed prosthesis. As the patient grew older, they developed facial asymmetry as a result of the prominent atrophy of their right cheek. By the age of 32, they had lost multiple teeth and exhibited severe facial deformity. Therefore, it is essential not only to involve a multidisciplinary medical team before, during, and after cancer therapy, but also to initiate long-term follow-ups given the potential effects of late sequelae after chemoradiation in multiple developmental areas.
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Seremidi K, Kavvadia K, Kattamis A, Polychronopoulou A. Dental late effects of antineoplastic treatment on childhood cancer survivors: Radiographic findings. Int J Paediatr Dent 2021; 31:742-751. [PMID: 33759247 DOI: 10.1111/ipd.12792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Dental anomalies are common late side effects of childhood cancer therapy and may lead to anatomical, functional, and aesthetic sequelae. AIM The study aimed to record dental late effects of antineoplastic treatment and associate them with disease and treatment characteristics in order to identify possible risk factors. DESIGN Orthopantomograms of 70 survivors aged 4-21 years, who were treated at ages 0-10 years for any type of malignancy and completed antineoplastic treatment at least one year before, were examined. Incidence of developmental disturbances was recorded. Their severity was calculated, and odds ratios for the development of severe defects were estimated. RESULTS Root defects presented in 62% of the participants, with impaired root growth being the most common (58%). Increased incidence was associated with combination treatment protocols, irradiation to the head and neck region, and administration of antimetabolites, steroids, and vincristine. Mean DeI value was 17.46 with risk factors for the development of severe root defects being diagnosis of acute lymphoblastic leukemia, combination treatment protocols, administration of cyclophosphamide and steroids, and hemopoietic stem cell transplantation. CONCLUSIONS Root defects are common among childhood cancer survivors, with their incidence and severity being affected by multiple disease and treatment characteristics.
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Affiliation(s)
- Kyriaki Seremidi
- Department of Pediatric Dentistry, Athens School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Kavvadia
- Division of Pediatric Dentistry, Department of Comprehensive Dentistry, University of Louisville, Louisville, KY, USA
| | - Antonis Kattamis
- Division of Pediatric Haematology-Oncology, First Department of Paediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyro Polychronopoulou
- Department of Preventive and Community Dentistry, Athens School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Long-Term Effects of Childhood Cancer Treatment on Dentition and Oral Health: A Dentist Survey Study from the DCCSS LATER 2 Study. Cancers (Basel) 2021; 13:cancers13215264. [PMID: 34771429 PMCID: PMC8582458 DOI: 10.3390/cancers13215264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/16/2021] [Accepted: 10/16/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary We aimed to identify the prevalence of and independent risk factors for dental and oral problems in childhood cancer survivors (CCSs). This cross-sectional study is part of the Dutch Childhood Cancer Survivor Study (DCCSS) LATER 2. Our study included survey data on 154 CCSs, on whom information from dentists on oral health data was received (71.3%). In total, 36.3% of survivors were reported to have at least one dental developmental disorder (DDD). The most prevalent DDDs were short-root anomaly (14.6%), agenesis (14.3%), and microdontia (13.6%). Risk factors for at least one DDD were younger age at diagnosis (<3 years vs. 5+ years) and dose-dependent alkylating agent therapy. This study provides more insight into risk factors for oral health problems in Dutch CCSs. This information is essential in order to improve early detection, prevention, and dental care of oral health problems in CCSs. Abstract Objectives: The aim of this study was to identify the prevalence of and independent risk factors for long-term effects of childhood cancer treatment on the dentition and oral health in childhood cancer survivors (CCSs). Methods: This cross-sectional study is part of the Dutch Childhood Cancer Survivor Study (DCCSS) LATER 2. CCSs were diagnosed with cancer between 1963 and 2001. This study focuses on survey data of 154 CCSs on whom information about their oral health was received from their dentists (71.3%). Descriptive statistics and univariable and multivariable Poisson regression analyses were performed to determine the association between treatment characteristics and oral health data. Results: Of the study group, 36.3% had at least one DDD. The most prevalent DDDs were short-root anomaly (14.6%), agenesis (14.3%), and microdontia (13.6%). Risk factors for at least one DDD were younger age at diagnosis (<3 years) and dose-dependent alkylating agent therapy. Conclusions: This study provides more insight into risk factors for oral health problems in Dutch CCSs. This information is essential in order to improve early detection, prevention, dental care, and quality of life. Further studies are needed in order to better define dose-related radiotherapy exposure of the developing teeth in correlation with oral health problems.
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Immonen E, Nikkilä A, Peltomäki T, Aine L, Lohi O. Late adverse effects of childhood acute lymphoblastic leukemia treatment on developing dentition. Pediatr Blood Cancer 2021; 68:e29200. [PMID: 34228397 DOI: 10.1002/pbc.29200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Childhood cancer survivors show a variety of late adverse effects on dental health. The purpose of this study was to examine the prevalence and severity of dental abnormalities in permanent dentition in childhood leukemia survivors. MATERIALS AND METHODS Retrospective analysis of panoramic radiographs was performed for 178 childhood leukemia survivors aged below 17 years at the time of diagnosis. Sex, age at diagnosis, interval between ALL diagnosis and the follow-up radiograph, treatment protocol, and risk grouping were recorded. Abnormalities of tooth development and defect index were used to assess the frequency and severity of dental abnormalities. RESULTS One hundred eight (61%) patients had no dental abnormalities at follow-up examination at a median of 6.1 years after diagnosis. Microdontia was more frequent in children under 6 years of age at the time of diagnosis (5.7% vs. 0.6%, p < .001). Significant differences were noted between distinct ALL treatment protocols with more common microdontia in patients treated according to the NOPHO ALL2008 protocol. Tooth agenesis was more frequent in patients that underwent therapy according to high-risk arms compared to intermediate- or standard-risk arms (3.8% vs. 1.4%, p = .01). Patients under 6 years of age at diagnosis had a significantly higher average defect index score than older patients (7.0 vs. 2.8, p = .01). CONCLUSIONS Children and adolescents who received ALL treatment were at risk for dental damage. Young age and high-intensity therapy were associated with the severity of dental abnormalities.
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Affiliation(s)
- Egle Immonen
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland
| | - Atte Nikkilä
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Cancer Center, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Timo Peltomäki
- Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Liisa Aine
- Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Olli Lohi
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Cancer Center, Tampere University and Tampere University Hospital, Tampere, Finland
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Ide Y, Nakahara T, Fukada T, Nasu M. Local Irradiation of Mouse Tooth Germ Gives Insight into the Direct Effects of Irradiation on Root Development. Radiat Res 2021; 196:602-610. [PMID: 34388821 DOI: 10.1667/rade-20-00081.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Abstract
To elucidate the mechanism underlying the failure of root formation after irradiation, we established a method of local irradiation of the molar tooth germ and demonstrated that radiation directly affected dental root development. In the current study, to locally irradiate the lower first molars of 5-day-old C57BL/6J mice, we used lead glass containing a hole as a collimator. We confirmed that our local irradiation method targeted only the tooth germ. The irradiated root was immature in terms of apical growth, and dentin formation was irregular along the outside of the root apices. Moreover, calcified tissue apically surrounded Hertwig's epithelial root sheath, which disappeared abnormally early. This method using a local irradiation experimental model will facilitate research into radiation-induced disorders of dental root formation.
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Affiliation(s)
- Yoshiaki Ide
- Department of Anatomy, The Nippon Dental University School of Life Dentistry at Tokyo.,Department of Developmental and Regenerative Dentistry, The Nippon Dental University School of Life Dentistry at Tokyo
| | - Taka Nakahara
- Department of Developmental and Regenerative Dentistry, The Nippon Dental University School of Life Dentistry at Tokyo
| | - Tetsuya Fukada
- Department of Pharmacology, The Nippon Dental University School of Life Dentistry at Tokyo
| | - Masanori Nasu
- Research Center for Odontology, The Nippon Dental University School of Life Dentistry at Tokyo
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Medina MCG, Bastos RTDRM, Mecenas P, Pinheiro JDJV, Normando D. Association between tooth agenesis and cancer: a systematic review. J Appl Oral Sci 2021; 29:e20200955. [PMID: 34378652 PMCID: PMC8360625 DOI: 10.1590/1678-7757-2020-0955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/06/2021] [Indexed: 11/26/2022] Open
Abstract
The congenital absence of multiple teeth may share the same genetic background of the development of some types of cancer. Objective: This systematic review aimed to investigate the possible association between dental agenesis and cancer, and the perspective of agenesis as an early predictor for cancer risk. Methodology: The electronic databases PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and OpenGrey were searched and the risk of bias was evaluated using the Newcastle-Ottawa tool. The GRADE tool was used to evaluate the certainty of the evidence. Results: Six studies met the eligibility criteria. A positive co-occurrence between ovarian cancer and hypodontia was found in two articles. Three studies evaluated the association between dental agenesis and colorectal cancer and only one showed common genes for these conditions. One paper found individuals with hypodontia had a higher risk of family history of cancer. Five studies had a fair quality and one a good quality. The certainty of evidence was classified as very low. Conclusion: Notwithstanding the limited scientific evidence, there may be a possible association between dental agenesis and cancer due to genes involved in both conditions. Agenesis of multiple teeth could be an early indicator of cancer risk. Nevertheless, studies with a better level of evidence are needed to confirm this possible association.
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Affiliation(s)
| | | | - Paulo Mecenas
- Universidade Federal do Pará, Programa de Pós-Graduação em Odontologia, Belém, Pará, Brasil
| | | | - David Normando
- Universidade Federal do Pará, Faculdade de Odontologia, Belém, Pará, Brasil
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Proc P, Szczepańska J, Zubowska M, Zalewska-Szewczyk B, Młynarski W. The Broad Variability in Dental Age Observed among Childhood Survivors Is Cancer Specific. Cancer Res Treat 2020; 53:252-260. [PMID: 32854493 PMCID: PMC7812002 DOI: 10.4143/crt.2020.275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/22/2020] [Indexed: 02/02/2023] Open
Abstract
PURPOSE The study aimed to assess the differences in dental maturation between childhood cancer survivors and healthy children. Materials and Methods Fifty-nine cancer patients including 16 (27.1%) girls and 43 (72.8%) boys, aged between 4 and 16 years, underwent dental and radiographic examinations. The mean duration of anticancer therapy was 16.8 months (range, 1 to 47 months), and 4.6 years (range, 8 to 123 months) had passed since the termination of disease. The control group consisted of 177 panoramic radiographs of age- and sex-matched healthy individuals. Dental age (DA) was estimated with Demirjian's scale and delta age, i.e., DA-chronological age (CA), was used to compare groups. RESULTS The DA of cancer survivors was accelerated by almost 1 year compared to their CA (9.9±3.1 vs. 8.9±2.8, p=0.040). The greatest difference was observed among patients with brain tumor: delta (DA-CA) was 2.2±1.1 years. Among all cancer patients, only children with familial adenomatous polyposis (FAP)-associated hepatoblastoma (HP) demonstrated delayed DA, with regard to both other cancer survivors (p=0.011) and healthy patients (p=0.037). All four patients with HP suffered from FAP, and three of them had documented adenomatous polyposis coli (APC) genes mutation. The DA of cancer patients having teeth with short roots was significantly greater than that of the cancer survivors without this anomaly (12.8±3.2 vs. 9.0±2.4, p < 0.001). CONCLUSION DA in children may be altered by cancer disease.
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Affiliation(s)
- Patrycja Proc
- Department of Pediatric Dentistry, Medical University of Lodz, Lodz, Poland
| | - Joanna Szczepańska
- Department of Pediatric Dentistry, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Zubowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | | | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
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Cammarata-Scalisi F, Girardi K, Strocchio L, Merli P, Bernardin AG, Galeotti A, Magliarditi F, Inserra A, Callea M. Oral Manifestations and Complications in Childhood Acute Myeloid Leukemia. Cancers (Basel) 2020; 12:cancers12061634. [PMID: 32575613 PMCID: PMC7352340 DOI: 10.3390/cancers12061634] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022] Open
Abstract
Acute myeloid leukemia (AML) is a heterogeneous group of diseases, whose classification is based on lineage-commitment and genetics. Although rare in childhood, it is the most common type of acute leukemia in adults, accounting for 80% of all cases in this age group. The prognosis of this disease remains poor (especially in childhood, as compared to acute lymphoblastic leukemia); however, overall survival has significantly improved over the past 30 years. The health of the oral cavity is a remarkable reflection of the systemic status of an individual. Identification of the signs and symptoms of oral lesions can act as a warning sign of hidden and serious systemic involvement. Moreover, they may be the presenting feature of acute leukemia and provide important diagnostic indicators. Primary oral alterations are identified in up to 90% of cases of acute myeloid leukemia and consist of petechiae, spontaneous bleeding, mucosal ulceration, gingival enlargement with or without necrosis, infections, hemorrhagic bullae on the tongue, and cracked lips. Poor oral hygiene is a well-known risk factor for local and systemic infectious complications. Oro-dental complications due to AML treatment can affect the teeth, oral mucosa, soft and bone tissue, and contribute to opportunistic infections, dental decay, and enamel discoloration. The treatment of acute myeloid leukemia is still associated with high mortality and morbidity. The management is multimodal, involving aggressive multidrug chemotherapy and, in most cases, allogenic bone marrow transplantation. Periodontal and dental treatment for patients with leukemia should always be planned and concerted with hematologists.
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Affiliation(s)
- Francisco Cammarata-Scalisi
- Pediatrics Service, Regional Hospital of Antofagasta, Antofagasta 12440, Chile
- Correspondence: (F.C.-S.); (M.C.)
| | - Katia Girardi
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (K.G.); (L.S.); (P.M.)
| | - Luisa Strocchio
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (K.G.); (L.S.); (P.M.)
| | - Pietro Merli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (K.G.); (L.S.); (P.M.)
| | | | - Angela Galeotti
- Unit of Dentistry, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (A.G.B.); (A.G.); (F.M.)
| | - Fabio Magliarditi
- Unit of Dentistry, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (A.G.B.); (A.G.); (F.M.)
| | | | - Michele Callea
- Unit of Dentistry, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (A.G.B.); (A.G.); (F.M.)
- Correspondence: (F.C.-S.); (M.C.)
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Nakatsugawa K, Kurosaka H, Inubushi T, Aoyama G, Isogai Y, Usami Y, Toyosawa S, Yamashiro T. Stage- and tissue-specific effect of cyclophosphamide during tooth development. Eur J Orthod 2019; 41:519-530. [PMID: 30715254 DOI: 10.1093/ejo/cjz002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the toxic effect of cyclophosphamide (CPA) in the development of rodent molars. METHODS CPA was administered intraperitoneally in postnatal mice between Day 1 and Day 10, and the morphological phenotype was evaluated at Day 26 using micro-computed tomography and histological analysis, including cell proliferation and cell death analyses. RESULTS M3 molars of the mice who received 100 mg/kg CPA treatment at Day 6 or M2 molars who received treatment at Day 1 resulted in tooth agenesis or marked hypoplasia. Histological observation demonstrated that CPA treatment at Day 6 resulted in shrinkage of the M3 tooth germs, with a significant reduction in the proliferation of apoptotic cells. Conversely, CPA exposure at Day 2, which occurs at around the bud stage of M3, resulted in crown and root hypoplasia, with reduced numbers of cusp and root. In addition, CPA exposure at Day 10, which is the late bell stage of M3, induced root shortening; however, it did not affect crown morphogenesis. LIMITATIONS The timing of CPA administration is limited to after birth. Therefore, its effect during the early stages of M1 and M2 could not be investigated. CONCLUSION Defective phenotypes were evident in both crown and roots due to the effect of CPA. Interestingly, the severity of the phenotypes was associated with the developmental stages of the tooth germs at the time of CPA administration. The cap/early bell stage is the most susceptive timing for tooth agenesis, whereas the late bell stage is predominantly affected in terms of root formation by CPA administration.
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Affiliation(s)
- Kohei Nakatsugawa
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Hiroshi Kurosaka
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Toshihiro Inubushi
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Gozo Aoyama
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Yukako Isogai
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Yu Usami
- Department of Oral Pathology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Satoru Toyosawa
- Department of Oral Pathology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Takashi Yamashiro
- Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry, Osaka, Japan
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Seremidi K, Kloukos D, Polychronopoulou A, Kattamis A, Kavvadia K. Late effects of chemo and radiation treatment on dental structures of childhood cancer survivors. A systematic review and meta-analysis. Head Neck 2019; 41:3422-3433. [PMID: 31228308 DOI: 10.1002/hed.25840] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/17/2019] [Accepted: 06/04/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This systematic review summarizes the prevalence of dental defects after chemo and radiation therapy and correlates the findings with specific characteristics of each treatment modality. METHODS Database search was performed for studies reporting dental late effects of chemo and radiation therapy. After data extraction and risk of bias assessment, prevalence of crown and root defects was assessed. Correlations between each defect and the characteristics of the antineoplastic treatment were performed. RESULTS Sixteen nonrandomized studies were included, yielding a total of 1300 patients with a mean age at diagnosis of 4.5 years. Results reported that root defects were more common than crown defects. The most common root defect was impaired root growth and microdontia the most common crown defect. Age, radiation dose and field were statistically associated with higher prevalence of dental defects. CONCLUSION Defects were associated with combination of chemotherapy and radiotherapy, as used in current therapeutic antineoplastic modalities.
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Affiliation(s)
- Kyriaki Seremidi
- Department of Paediatric Dentistry, Athens School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kloukos
- Department of Orthodontics, 251 Greek Air Force Hospital, Athens, Greece.,Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Argy Polychronopoulou
- Department of Preventive and Community Dentistry, Athens School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Kattamis
- Division of Paediatric Haematology-Oncology, First Department of Paediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Kavvadia
- Department of Comprehensive Dentistry, Division of Pediatric Dentistry, University of Louisville, Louisville, Kentucky
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Freycon F, Casagranda L, Trombert-Paviot B. The impact of severe late-effects after 12 Gy fractionated total body irradiation and allogeneic stem cell transplantation for childhood leukemia (1988-2010). Pediatr Hematol Oncol 2019; 36:86-102. [PMID: 30978121 DOI: 10.1080/08880018.2019.1591549] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study consists of a retrospective study including 71 childhood leukemia survivors (36 females) treated with allo-HSCT 12 Gy fractionated total body irradiation (fTBI) conditioning, with a median age of 25.0 y at time of follow-up and a median delay of 14.8 y since the graft. The recovery ratio was 90%. The number of severe late-effects was specified for each patient: 21 with growth deficiency (final height <162.5 cm for 12/35 men and <152.0 cm for 9/36 women - Growth deficiency was correlated to young age at the time of the allograft); 5 with sclerodermic chronic graft vs. host disease; 9 with osteonecrosis; risk of impaired fertility for 25 women and 28 men (only 2 women had a child); 8 with diabetes; 5 with pulmonary late-effects including 1 death; 5 with chronic renal insufficiency including 1 death; 2 with cardiac late-effects; 2 with arterial high blood pressure; 11 (8 women) declared 14 subsequent cancers (7 with thyroid carcinomas, 3 with multiple squamous cell carcinomas, 2 with epidermoïdis carcinomas of the tongue or the lip, 1 with bone sarcoma, and 1 with carcinoma of the breast); 6 with chelating treatments of hemochromatosis; 14 with important educational underachievement; 11 with depression at adult age; 1 with hepatitis B virus infection; 4 with other severe late-effects, including 2 with blindness. The average number of severe late-effects was 2.3 with a positive correlation according to delay from fTBI (p < 0.0002). Two-thirds had at least 2 late-effects. These results emphasize the urgent abandonment of conditioning by TBI in children.
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Affiliation(s)
- Fernand Freycon
- a Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France
| | - Léonie Casagranda
- a Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France.,b Department of Pediatric Hematology and Oncology Unit , University Hospital of Saint-Etienne , Saint-Etienne , France.,c Host Research Team EA4607 SNA-EPIS, PRES Lyon, Jean Monnet University, University Hospital , Saint-Etienne , France
| | - Béatrice Trombert-Paviot
- c Host Research Team EA4607 SNA-EPIS, PRES Lyon, Jean Monnet University, University Hospital , Saint-Etienne , France.,d Department of Public Health and Medical Informatics , University of Saint-Etienne , Saint-Etienne , France
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Hernandez M, Pochon C, Chastagner P, Droz D. Long-term Adverse Effects of Acute Myeloid Leukemia Treatment on Odontogenesis in a Child. Int J Clin Pediatr Dent 2019; 12:243-246. [PMID: 31708623 PMCID: PMC6811937 DOI: 10.5005/jp-journals-10005-1614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Several studies showed that cancer therapies during tooth development are associated with dental abnormalities, including enamel defects, arrested tooth development, microdontic teeth, and agenesis. Study design We describe the case of a nine-year-old boy treated for acute myeloid leukemia at 15 months of age, who presents several dental abnormalities resulting from anticancer treatment. Results The patient was included and treated according to the ELAM 02 French protocol. Six years after allogenic hematopoietic stem cell transplantation, the intraoral and radiographic examination highlighted the agenesis of the second permanent molars and three of the four second premolars, microdontia of the first premolars, root stunting of the central incisors and first premolars, rootlessness of the first permanent molars, and enamel defects localized at the permanent incisors and canines. As a first step to reduce enamel defects, restorations with resin composite (Tetric EvoCeram® A2, Ivoclar Vivadent) were performed under a dental dam. Orthodontic treatment was contraindicated due to arrested tooth development, short roots, and a risk of resorption is considered too important. Conclusion The young age at diagnosis (<5 years of age) and intensive chemotherapy (especially myeloablative conditioning with high doses of cyclophosphamide and Busulfan) could explain the severity of the dental abnormalities. This case illustrates the importance of systematically scheduling a dental follow-up in parallel with the onco-hematologic follow-up allowing the clinicians to prevent, detect, and propose early intervention for dental late effects. How to cite this article Hernandez M, Pochon C, et al. Long-term Adverse Effects of Acute Myeloid Leukemia Treatment on Odontogenesis in a Child. Int J Clin Pediatr Dent 2019;12(3):243–246.
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Affiliation(s)
- Magali Hernandez
- Pediatric Dentistry Department, Children Hospital, CHRU Nancy, France; Pediatric Dental Department, Faculty of Dentistry, Nancy, France
| | - Cécile Pochon
- Hematology, Oncology Department, Children Hospital, CHRU Nancy, France
| | - Pascal Chastagner
- Hematology, Oncology Department, Children Hospital, CHRU Nancy, France
| | - Dominique Droz
- Pediatric Dentistry Department, Children Hospital, CHRU Nancy, France; Pediatric Dental Department, Faculty of Dentistry, Nancy, France
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Mattos VDD, Ferman S, Magalhães DMA, Antunes HS, Lourenço SQC. Dental and craniofacial alterations in long-term survivors of childhood head and neck rhabdomyosarcoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:272-281. [PMID: 30685390 DOI: 10.1016/j.oooo.2018.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/26/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Rhabdomyosarcoma (RMS) represents the most common soft tissue sarcoma that affects children. Treatment involves chemoradiotherapy. This study aimed at evaluating the long-term alterations to teeth and cranial bones in children, teenagers, and young adults after oncologic treatment. STUDY DESIGN We conducted a cross-sectional study of patients undergoing treatment for head and neck RMS between 1988 and 2011. We evaluated demographic, clinical, and treatment data and performed panoramic radiography, cephalometry, and photography. RESULTS We evaluated 27 long-term survivors, most of whom had been treated between ages 0 to 5 years (51.9%). The total radiation dose applied was 50.4 Gy, and the chemotherapy combination included vincristine, actinomycin D, and cyclophosphamide in 51.9% of the cases. We observed 603 dental alterations, among which 377 (62.7%) occurred in patients ages 0 to 5 years, and root shortening was the most frequent alteration observed (24.2%). With regard to facial bones, 74% of the patients had some level of facial asymmetry, 70.4% had reduced facial depth, 48.4% had mandibles of short size, and 77.8% had reduced facial height. CONCLUSIONS Children submitted to RMS treatment involving chemotherapy and radiotherapy displayed significant dental and craniofacial alterations, especially when treatment occurred between ages 0 and 5 years.
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Affiliation(s)
| | - Sima Ferman
- Pediatric Oncology Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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Kılınç G, Bulut G, Ertuğrul F, Ören H, Demirağ B, Demiral A, Aksoylar S, Kamer ES, Ellidokuz H, Olgun N. Long-term Dental Anomalies after Pediatric Cancer Treatment in Children. Turk J Haematol 2018; 36:155-161. [PMID: 30322830 PMCID: PMC6682778 DOI: 10.4274/tjh.galenos.2018.2018.0248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: The aim of this study is to determine the frequency of dental anomalies (DAs) (microdontia, hypodontia, hyperdontia, enamel defect, root malformation) in pediatric cancer patients at the ages <5 years and between 5 and 7 years, and understand their relationship with the received therapy. Materials and Methods: Pediatric patients who were diagnosed with cancer and treated before the age of 7 years were investigated in a case- control design. The study included 93 pediatric patients whose ages at diagnosis were between 9 months and 7 years and whose treatments were completed before 5-8 years. Group A consisted of patients in the age range of 9 months to 4 years and Group B consisted of patients in the age range of 5-7 years. Seventy-two siblings with compatible dental age ranges were included in the control group. For both groups, intraoral examinations were performed and panoramic radiographs were taken. Results: Among the 93 pediatric patients, the mean age was 9.54±1.25 (range: 8-13 years) and 48 (51.6%) patients were male. The most common diagnosis was hematologic malignancy with a rate of 65.5%. At least one DA was detected in 7 (9.7%) individuals of the control group and in 78 (83.9%) of the patient group. While the patients in the study group had all kinds of DAs, those in the control group had only enamel defects. The rates of microdontia (p=0.077) and hypodontia (p=0.058) were detected to be significantly higher in Group A than in Group B. Root malformation was more common in patients receiving chemotherapy and radiotherapy than in those receiving only chemotherapy (p=0.006). Conclusion: In this study it was found that the pediatric patients who received cancer treatment before the age of 7 years constituted a high-risk group for DAs. The frequencies of microdontia and hypodontia were increased even more when the patient was treated for cancer before 5 years of age.
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Affiliation(s)
- Gülser Kılınç
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Dentistry, İzmir, Turkey
| | - Gülçin Bulut
- İzmir Training Dental Hospital, Clinic of Pediatric Dentistry, İzmir, Turkey
| | - Fahinur Ertuğrul
- Ege University Faculty of Dentistry, Department of Pedodontics, İzmir, Turkey
| | - Hale Ören
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Bengü Demirağ
- Behçet Uz Children’s Hospital, Clinic of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Ayşe Demiral
- Dokuz Eylül University Faculty of Medicine, Department of Radiation Oncology, İzmir, Turkey
| | - Serap Aksoylar
- Ege University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey
| | - Emine Serra Kamer
- Ege University Faculty of Medicine, Department of Radiation Oncology, İzmir, Turkey
| | - Hülya Ellidokuz
- Dokuz Eylül University, Institute of Oncology, Department of Preventive Oncology, İzmir, Turkey
| | - Nur Olgun
- Dokuz Eylül University, Institute of Oncology, Department of Pediatric Oncology, İzmir, Turkey
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Doane CJ, Patil K, Hoffman EA, Stokes J, Katsanis E, Besselsen DG. Supernumerary Incisors in CB6F1 Mice Conditioned with Chemotherapy and Total Body Irradiation before Bone Marrow Transplantation. Comp Med 2018; 68:349-352. [PMID: 30208992 PMCID: PMC6200027 DOI: 10.30802/aalas-cm-18-000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/29/2018] [Accepted: 05/18/2018] [Indexed: 11/05/2022]
Abstract
Multiple adult female CB6F1 mice presented with supernumerary incisors after preconditioning with chemotherapy and total body irradiation for bone marrow transplantation (BMT). Mice received nonmyeloablative total body irradiation (3 Gy) and either cyclophosphamide or bendamustine, followed by BMT and posttransplantation cyclophosphamide or bendamustine. Here we describe the clinical presentation, μCT findings, and histopathologic evaluation of the affected mice. These analyses confirmed the gross diagnosis and revealed details of the abnormal tooth morphology. We surmise that the combination of total body irradiation and chemotherapy resulted in the abnormal formation of supernumerary incisors. Supernumerary teeth should be considered as a potential confounding factor in tracking weight loss after BMT. These conditions can be managed to allow animals to reach their intended scientific endpoint.
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Affiliation(s)
- Cynthia J Doane
- University Animal Care, University of Arizona, Tucson, Arizona, USA.
| | - Karuna Patil
- University Animal Care, University of Arizona, Tucson, Arizona, USA
| | - Emely A Hoffman
- Departments of Pediatrics, University of Arizona, Tucson, Arizona, USA
| | - Jessica Stokes
- Departments of Pediatrics, University of Arizona, Tucson, Arizona, USA
| | - Emmanuel Katsanis
- Department of Immunobiology, University of Arizona Cancer Center, Tucson, Arizona, USA
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Impact of Hematopoietic Stem Cell Transplantation on Dental Development. Biol Blood Marrow Transplant 2018; 25:107-113. [PMID: 30189246 DOI: 10.1016/j.bbmt.2018.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 08/28/2018] [Indexed: 11/23/2022]
Abstract
To investigate dental development in patients treated with a hematopoietic stem cell transplantation (HSCT), 42 children and young adults who were under 12 years old at time of HSCT were examined for dental agenesis, microdontia, and root-to-crown ratio. Conditioning regimens were total body irradiation (TBI) based in 12 patients, busulfan based in 21 patients, and 9 patients had other chemotherapeutic agents. Sixteen patients were <3 years old, 9 patients were 3 to 6 years old, and 17 patients were 6 to 12 years old at HSCT. Prevalence of agenesis and microdontia of at least 1 permanent tooth were, respectively, 51.3% and 46.2% in the study population, and 76.3% had an aberrant root-to-crown ratio. All these results were highly different from the prevalence in the healthy population. Patients treated before the age of 3 years had more microdontia (76.9%) and agenesis (92.3%) compared with patients treated at an older age. In the subgroup of patients treated after 6 years, there was more microdontia when treated with busulfan (50%) compared with treatment with TBI (0%) (P = .044). Patients treated with HSCT had many disturbances in dental development. Age at HSCT and possibly also the conditioning regimen used had an effect on their type and prevalence. Dental follow-up should be incorporated in the multidisciplinary follow-up program of these patients.
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Busenhart DM, Erb J, Rigakos G, Eliades T, Papageorgiou SN. Adverse effects of chemotherapy on the teeth and surrounding tissues of children with cancer: A systematic review with meta-analysis. Oral Oncol 2018; 83:64-72. [DOI: 10.1016/j.oraloncology.2018.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 11/29/2022]
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Kang CM, Hahn SM, Kim HS, Lyu CJ, Lee JH, Lee J, Han JW. Clinical Risk Factors Influencing Dental Developmental Disturbances in Childhood Cancer Survivors. Cancer Res Treat 2018; 50:926-935. [PMID: 29020731 PMCID: PMC6056986 DOI: 10.4143/crt.2017.296] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/30/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Although studies regarding dental developmental disturbances after childhood cancer treatment have increased, they have many limitations. Studies analyzing the significance of independent clinical risk factors with regard to the dental health status are also rare. We aimed to investigate the risk factors for dental developmental disturbances, particularly severe disturbances, in childhood cancer survivors (CCS). MATERIALS AND METHODS Oral examinations and retrospective reviews of medical and panoramic radiographs were performed for 196 CCS (mean age, 15.6 years). Cancer type, age at diagnosis, treatment modality, type and accumulated dose of administered drugs, and dose and site of radiation were recorded. Dental developmental disturbances were diagnosed using panoramic radiographs and graded for severity according to the Modified Dental Defect Index (MDDI). Descriptive statistics and multivariate analyseswere performed to determine the association between dental abnormalities and clinical factors. RESULTS In total, 109 CCS (55.6%) exhibited at least one dental anomaly, and the median value of MDDI was 2.5. Microdontia (30.6%) was the most prevalent anomaly, followed by tooth agenesis (20.4%), V-shaped roots (14.8%), and taurodontism (10.2%). Multivariate analysis revealed that a young age at diagnosis (≤ 3 years), a history of hematopoietic stem cell transplantation, the use of multiple classes of chemotherapeutic agents (≥ 4 classes), and the use of heavy metal agents were significant risk factors for severe dental disturbances. CONCLUSION CCS with any of the above risk factors for severe developmental disturbances should be comprehensively followed up to minimize adverse consequences to their dental development and preserve their future dental health.
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Affiliation(s)
- Chung-Min Kang
- Department of Pediatric Dentistry, Yonsei University College of Dentistry, Seoul, Korea
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Hahn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hyo Sun Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Chuhl Joo Lyu
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jae-Ho Lee
- Department of Pediatric Dentistry, Yonsei University College of Dentistry, Seoul, Korea
| | - Jinae Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Woo Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
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Al-Ani AH, Antoun JS, Thomson WM, Merriman TR, Farella M. Maternal Smoking during Pregnancy Is Associated with Offspring Hypodontia. J Dent Res 2017; 96:1014-1019. [PMID: 28535361 DOI: 10.1177/0022034517711156] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Little is known about environmental risk factors for hypodontia. The objective of this study was to investigate the association between hypodontia and common environmental risk factors, such as maternal smoking and alcohol and caffeine consumption during pregnancy. Eighty-nine hypodontia cases with 1 or more missing permanent lateral incisors and/or 1 or more missing premolars were enrolled in this clinic-based case-control study. Some 253 controls with no missing teeth were frequency matched to cases by age and sex. Hypodontia was diagnosed using panoramic radiographs. Sociodemographic data were collected from both the participants and their mothers, with maternal self-reported active and passive smoking, as well as alcohol and caffeine consumption during pregnancy, assessed by a questionnaire. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated with logistic regression to assess the strength of association between risk factors and hypodontia. OR estimates were then adjusted for possible confounders, such as maternal age at delivery, sex and gestational age of the child, and household socioeconomic background. Significant associations were found between hypodontia and maternal cigarette use during pregnancy, as well as the number of cigarettes smoked per day. The consumption of 10 or more cigarettes per day during pregnancy was associated with greater odds of having a child with hypodontia (adjusted OR, 4.18; 95% CI, 1.48-11.80; P = 0.007). Observed associations between hypodontia, second-hand smoke, and alcohol and caffeine consumption were not statistically significant. Maternal smoking during pregnancy is associated with hypodontia. Larger samples and prospective observational study designs, however, are needed to investigate this association further.
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Affiliation(s)
- A H Al-Ani
- 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - J S Antoun
- 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - W M Thomson
- 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - T R Merriman
- 2 Department of Biochemistry, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - M Farella
- 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Increasing Risk of Disturbed Root Development in Permanent Teeth in Childhood Cancer Survivors Undergoing Cancer Treatment at Older Age. J Pediatr Hematol Oncol 2017; 39:e150-e154. [PMID: 28234739 DOI: 10.1097/mph.0000000000000788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Structural anomalies of teeth are observed at high rates in childhood cancer survivors (CCS). Several therapeutic exposures have been shown to be associated with dental developmental disturbances. This study was conducted to analyze the risk factors for dental developmental abnormality (DDA) and investigate the association between age at the time of cancer treatment and DDA in CCS. PATIENTS AND METHODS Fifty-six CCS were enrolled. Orthopantomography and dental examination were performed in all the patients. We evaluated the prevalence of DDA and analyzed the risk factors for each type of DDA. RESULTS DDAs were observed in 46.4% of CCS, including hypodontia in 9 (16.1%), abnormal roots in nine (16.1%), enamel defects/hypoplasia in 6 (10.7%), and microdontia in 12 (21.4%) patients. The number of patients with abnormal roots was significantly higher in the group treated with stem cell transplantation or at an age older than 4 years. We observed that the formation period of abnormal teeth coincided with the treatment period in the majority of CCS with DDA. CONCLUSIONS Particularly regarding the root abnormality, treatment at elder age may be a risk factor for root developmental disturbances. Risk evaluation, appropriate follow-up, and early detection of dental issues are required for all CCS.
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Krasuska-Sławińska E, Brożyna A, Dembowska-Bagińska B, Olczak-Kowalczyk D. Antineoplastic chemotherapy and congenital tooth abnormalities in children and adolescents. Contemp Oncol (Pozn) 2016; 20:394-401. [PMID: 28373822 PMCID: PMC5371707 DOI: 10.5114/wo.2016.64602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 11/30/2015] [Indexed: 11/26/2022] Open
Abstract
AIM OF THE STUDY Chemotherapeutic treatment in children and adolescents carries a risk of congenital tooth disorders and dentinoma. Study objective is to assess the correlation between tooth abnormalities, early complications of multidrug chemotherapy, and chemotherapeutics used in different antineoplastic therapies in children and adolescents. MATERIAL AND METHODS Enamel defects (developmental defects of enamel index - DDE index) and defects in tooth number, size, and structure were assessed clinically and radiologically in 60 patients who underwent chemotherapy on average 4.9 ±3.4 years earlier (PCH), and 60 generally healthy subjects (control group - CG), aged 6-18 years. Höltta's defect index (DeI) was calculated. Medical files provided information on neoplasm type, age at treatment start and chemotherapy duration, chemotherapeutic type and dose, vomiting, and mucositis (CTCAE v4.0). Statistical significance of differences between groups was assessed with the Mann-Whitney U test and the correlation between dental defects and chemotherapy with Spearman's rank correlation coefficient (significance p ≤ 0.05). RESULTS Enamel defects, tooth agenesis, microdontia, root resorption, taurodontism, and dentinoma occurred statistically significantly more often in the PCH group. A correlation was established between vincristine use and dose and all types of dental defects; cyclophosphamide, doxorubicin, and isophosphamide and hypodontia; microdontia, root resorption, and enamel defects; etoposide and cisplatin and microdontia, root resorption, and enamel defects; methotrexate root resorption and enamel defects; carboplatin and dentinoma and enamel defects. Mucositis and vomiting promoted root resorption, microdontia, and enamel defects. CONCLUSIONS Dental defects are related to both the use of respective chemotherapeutics, especially vincristine, cyclophosphamide, doxorubicin, and isophosphamide, and to early complications in multidrug chemotherapy - mucositis and vomiting. Vincristine and carboplatin use may promote dentinoma.
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Affiliation(s)
| | - Agnieszka Brożyna
- Department of Paediatric Oncology, Children Memorial Hospital, Warsaw, Poland
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Krasuska-Sławińska E, Brożyna A, Dembowska-Bagińska B, Olczak-Kowalczyk D. Factors influencing caries incidence in permanent teeth in children/adolescents under and after anti-neoplastic treatment. Contemp Oncol (Pozn) 2016; 20:45-51. [PMID: 27095939 PMCID: PMC4829740 DOI: 10.5114/wo.2015.55319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 11/19/2014] [Indexed: 11/23/2022] Open
Abstract
AIM OF THE STUDY To determine reasons for the increase in caries among children/adolescents treated for neoplasms. MATERIAL AND METHODS Health promoting behaviour, oral hygiene (PLI), gingiva (GI), dentition (DMFt/DMFs), number of teeth with white spot lesions (WSL), and enamel defects (ED) were assessed in three groups of 60 patients each. The three groups were as follows: under chemotherapy (CH), after chemotherapy (PCH), and generally healthy (CG). Medical files supplied information on neoplasm type, chemotherapeutic type and dose, age at treatment start, chemotherapy duration, and complications. Statistical analysis was performed with Mann-Whitney U test and Spearman's rho test. RESULTS The age at which chemotherapy was started/its duration was 5.9 ±4.0/1.3 ±0.5 years in PCH and 9.12 ±4.44/0.8 ±0.3 years in CH; PCH completed treatment 4.9 ±3.4 years ago. Chemotherapy most often included vincristine (VCR), etoposide (VP-16), adriamycin (ADM), cyclophosphamide (CTX), cisplatin (CDDP), and ifosphamide (IF). Mucositis occurrence was 28.33% in PCH and 45.00% in CH; vomiting occurrence was 43.33% and 50.00%, respectively. Nutrition and prophylaxis mistakes occurred more often in CH/PCH than in CG; PLI, GI, caries incidence and severity, and the number of teeth with WSL were higher. Correlation between caries incidence and chemotherapeutic type and dose, age at treatment start and treatment duration, mucositis, emesis, PLI, GI, ED, no fluoride prophylaxis, and nutritional mistakes was established. Ifosphamide and mucositis treatment played a major role in chemotherapy; after chemotherapy - ED and CTX, ADM, IF, and VP-16. CONCLUSIONS Caries in permanent teeth in children/adolescents undergoing chemotherapy result from nutritional mistakes, poor prophylaxis, and indirectly from chemotherapy complications (first mucositis and emesis, and later developmental ED).
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Proc P, Szczepańska J, Skiba A, Zubowska M, Fendler W, Młynarski W. Dental Anomalies as Late Adverse Effect among Young Children Treated for Cancer. Cancer Res Treat 2015; 48:658-67. [PMID: 26511809 PMCID: PMC4843721 DOI: 10.4143/crt.2015.193] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/10/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose The aim of this study was to compare the incidence of dental complications in childhood cancer survivors with that of healthy control subjects, and to determine the possible influence of various factors associated with patient and treatment. Materials and Methods Sixty-one panoramic radiographs of the dentition of cancer survivors were compared with 521 radiographs of healthy patients at a similar age, between 5 and 18 years. The mean period from termination of therapy was 4.9 years (58.9±34.3 months), and 51 children (83.60%) were under age 5 when therapy began. Results Dental anomalies were found in 38 cancer survivors (62.29%) and 69 control subjects (13.24%) (p < 0.001). Agenesis of teeth was found in 19 cancer patients (31.14%) and in 48 control subjects (9.21%). Microdontic teeth were found in 22 cancer survivors (36.06%) and 15 control subjects (2.87%) (p < 0.001), whereas teeth with short roots were found in seven cancer patients (11.47%) and 15 control subjects (2.87%) (p < 0.01). Dental anomalies in cancer patients were more common in some tooth groups and were not observed in others. The frequency of dental anomalies did not show correlation with age at the beginning or termination or time of therapy. Conclusion Children under the age of 5 are in a high risk group for dental complications after anticancer treatment. Rudimentary chemotherapy has a considerable impact on the occurrence of dental anomalies.
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Affiliation(s)
- Patrycja Proc
- Department of Pediatric Dentistry, Oncology, Hematology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Joanna Szczepańska
- Department of Pediatric Dentistry, Oncology, Hematology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Adam Skiba
- Department of Orthodontics, Oncology, Hematology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Małgorzata Zubowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Wojciech Fendler
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, Łódź, Poland
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Dental abnormalities after chemotherapy in long-term survivors of childhood acute lymphoblastic leukemia 7–40 years after diagnosis. Support Care Cancer 2015; 24:1497-506. [DOI: 10.1007/s00520-015-2940-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
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Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Van Lint MT, Wingard JR, Tichelli A. [Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation]. Bone Marrow Transplant 2014; 47:337-41. [PMID: 24975331 DOI: 10.1038/bmt.2012.5] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplantation exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
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Carrillo CM, Corrêa FNP, Lopes NNF, Fava M, Odone Filho V. Dental anomalies in children submitted to antineoplastic therapy. Clinics (Sao Paulo) 2014; 69:433-7. [PMID: 24964309 PMCID: PMC4050327 DOI: 10.6061/clinics/2014(06)11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 11/18/2022] Open
Abstract
Cancer is the third most frequent cause of death in children in Brazil. Early diagnosis and medical advances have significantly improved treatment outcomes, which has resulted in higher survival rates and the management of late side effects has become increasingly important in caring for these patients. Dental abnormalities are commonly observed as late effects of antineoplastic therapy in the oral cavity. The incidence and severity of the dental abnormalities depend on the child's age at diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area. The treatment duration and aggressivity should also be considered. Disturbances in dental development are characterized by changes in shape, number and root development. Enamel anomalies, such as discoloration, opacities and hypoplasia are also observed in these patients. When severe, these abnormalities can cause functional and esthetic sequelae that have an impact on the children's and adolescents' quality of life. General dentists and pediatric dentists should understand these dental abnormalities and how to identify them aiming for early diagnosis and appropriate treatment.
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Affiliation(s)
- Camila Merida Carrillo
- Hemato-oncology Service, Dentistry Department, Instituto da Criança ITACI, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Nilza Nelly Fontana Lopes
- Pediatric Oncology Institute, GRAACC-IOP, Department of Dentistry, School of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marcelo Fava
- Hemato-oncology Service, Dentistry Department, Instituto da Criança ITACI, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vicente Odone Filho
- Department of Pediatric, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Ide Y, Nakahara T, Nasu M, Ishikawa H. Cell dynamics in Hertwig's epithelial root sheath and surrounding mesenchyme in mice irradiated to the head. Oral Dis 2014; 21:232-9. [DOI: 10.1111/odi.12253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/22/2014] [Accepted: 04/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Y Ide
- Department of Developmental and Regenerative Dentistry; School of Life Dentistry at Tokyo; The Nippon Dental University; Tokyo Japan
| | - T Nakahara
- Department of Developmental and Regenerative Dentistry; School of Life Dentistry at Tokyo; The Nippon Dental University; Tokyo Japan
| | - M Nasu
- Research Center for Odontology; School of Life Dentistry at Tokyo; The Nippon Dental University; Tokyo Japan
| | - H Ishikawa
- Department of NDU Life Sciences; The Nippon Dental University School of Life Dentistry at Tokyo; The Nippon Dental University; Tokyo Japan
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Nemeth O, Kivovics M, Pinke I, Marton K, Kivovics P, Garami M. Late effects of multiagent chemotherapy on salivary secretion in children cancer survivors. J Am Coll Nutr 2014; 33:186-91. [PMID: 24835469 DOI: 10.1080/07315724.2013.834802] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the later oral consequences of chemotherapy on the oral health of children with emphasis on the cariological status and the major and minor salivary gland function. METHOD Thirty-eight 12-year-old children (mean age 12.3 ± 0.58 years) who underwent chemotherapy were evaluated after 5 years of treatment. Forty age- and sex-matched healthy children with similar socioeconomic backgrounds served as controls. Subjects' cariological status was explained by the number of decayed, filled, missing permanent teeth (DMF-T), and unstimulated and stimulated whole saliva flow rates were measured by the spitting method. Palatal saliva flow rate using a Periotron meter (Oraflow Inc., Plainview, NY) and salivary buffer capacity using CRT buffer (Ivoclar Vivadent AG, Schaan, Lichtenstein) were also investigated. RESULTS Children who underwent chemotherapy had significantly more decayed teeth than healthy controls (3.97 ± 3.58 vs 0.84 ± 1.75, respectively, p < 0.001). Recipients of chemotherapy had significantly lower stimulated whole saliva flow rate (0.84 ± 0.35 vs 1.13 ± 0.46 ml/min, p < 0.05) compared to the controls. Palatal saliva flow rate was at the same time significantly higher in the test group compared to the controls (1.64 ± 0.87 vs 0.46 ± 0.32 ml/min/cm(2), respectively, p < 0.001). High levels of buffer capacity of the saliva could be detected in a significantly higher prevalence in the patient group compared to the controls (high: 81.6% vs 40%). CONCLUSIONS According to these results, chemotherapy in children might result in a decreased stimulated whole saliva flow rate, hyposalivation, and, consequently, increased caries risk. Although these processes might be compensated to a limited extend by the increased minor saliva flow rate, resulting in a higher buffer capacity, nutrition and oral hygiene control of children obtaining cancer therapy is essential in the preservation of the oral tissues.
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Affiliation(s)
- Orsolya Nemeth
- a Department of Pediatrics , Semmelweis University , Budapest , Hungary
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46
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Effinger KE, Migliorati CA, Hudson MM, McMullen KP, Kaste SC, Ruble K, Guilcher GMT, Shah AJ, Castellino SM. Oral and dental late effects in survivors of childhood cancer: a Children's Oncology Group report. Support Care Cancer 2014; 22:2009-19. [PMID: 24781353 PMCID: PMC4118932 DOI: 10.1007/s00520-014-2260-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 04/16/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE Multi-modality therapy has resulted in improved survival for childhood malignancies. The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers provide practitioners with exposure- and risk-based recommendations for the surveillance and management of asymptomatic survivors who are at least 2 years from completion of therapy. This review outlines the pathophysiology and risks for oral and dental late effects in pediatric cancer survivors and the rationale for oral and dental screening recommended by the Children's Oncology Group. METHODS An English literature search for oral and dental complications of childhood cancer treatment was undertaken via MEDLINE and encompassed January 1975 to January 2013. Proposed guideline content based on the literature review was approved by a multi-disciplinary panel of survivorship experts and scored according to a modified version of the National Comprehensive Cancer Network "Categories of Consensus" system. RESULTS The Children's Oncology Group oral-dental panel selected 85 relevant citations. Childhood cancer therapy may impact tooth development, salivary function, craniofacial development, and temporomandibular joint function placing some childhood cancer survivors at an increased risk for poor oral and dental health. Additionally, head and neck radiation and hematopoietic stem cell transplantation increase the risk of subsequent malignant neoplasms in the oral cavity. Survivors require routine dental care to evaluate for potential side effects and initiate early treatment. CONCLUSIONS Certain childhood cancer survivors are at an increased risk for poor oral and dental health. Early identification of oral and dental morbidity and early interventions can optimize health and quality of life.
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Affiliation(s)
- Karen E Effinger
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Stanford University, 1000 Welch Rd, Suite 300, Palo Alto, CA, 94304, USA,
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Gawade PL, Hudson MM, Kaste SC, Neglia JP, Constine LS, Robison LL, Ness KK. A systematic review of dental late effects in survivors of childhood cancer. Pediatr Blood Cancer 2014; 61:407-16. [PMID: 24424790 PMCID: PMC4281834 DOI: 10.1002/pbc.24842] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/08/2013] [Indexed: 11/10/2022]
Abstract
Survivors of childhood cancer are at risk for dental late effects. This systematic review summarizes associations between treatment exposures and dental late effects among survivors of childhood cancer. We included investigations with at least 20 study participants conducted for 2 or more years after completion of childhood, adolescent, or young adult cancer therapy. This review suggests both independent and additive effects of radiotherapy and chemotherapy on dental complications, and identifies vulnerable groups with specific host and treatment characteristics. This summary provides information that will assist clinicians to prevent, detect, and facilitate early intervention for dental late effects.
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Affiliation(s)
- Prasad L. Gawade
- Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN 38105
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN 38105 ,Oncology, St. Jude Children’s Research Hospital, Memphis, TN
38105
| | - Sue C. Kaste
- Oncology, St. Jude Children’s Research Hospital, Memphis, TN
38105 ,Radiological Sciences at St. Jude Children’s Research
Hospital, Memphis, TN 38105 ,Department of Radiology, College of Medicine, University of
Tennessee Health Science Center, 910 Madison, Suite 1002, Memphis, TN 38163
| | - Joseph P. Neglia
- Department of Pediatrics, University of Minnesota Medical School,
Minneapolis, MN 55455
| | - Louis S. Constine
- Departments of Radiation Oncology and Pediatrics, School of Medicine
and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 647,
Rochester, NY 14642
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN 38105
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN 38105
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Mitomi T, Kawano Y, Kinoshita-Kawano S. Effect of the antineoplastic agent busulfan on rat molar root development. Arch Oral Biol 2014; 59:47-59. [PMID: 24404577 DOI: 10.1016/j.archoralbio.2013.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The antineoplastic bifunctional-alkylating agent busulfan (Bu) induces developmental anomalies. We examined histopathological changes in the molar roots of rats that received Bu at different stages of root formation. DESIGN At different developmental stages, i.e., on postnatal days (P) 13, 15, and 19, rats were administered 7.5 mg/kg of Bu dissolved in dimethyl sulfoxide (DMSO) and then killed on P 30. After micro-computed tomography analysis, the maxillary first molars underwent immunohistochemical analysis for cytokeratin 14 (CK14), nestin, and dentin sialoprotein (Dsp). This was followed by histomorphometric analysis. RESULTS The rats receiving Bu at an early stage (i.e., P 13 and P 15) showed osteodentin formation and complete destruction of the Hertwig's epithelial root sheath (HERS). Cells around osteodentin showed nestin and Dsp immunoreactivity. The root lengths in rats treated with Bu at P 13 (1228.44 ± 62.17 μm) and P 15 (1536.08 ± 109.71 μm) were lower than that in the control rats (1674.10 ± 40 μm). A narrowed apical foramen and an increased amount of osteodentin were also present, depending on the rat's age at the time of treatment (P < 0.05). CONCLUSION Busulfan treatment in juvenile rats resulted in abnormal root development, depending on the stage at which Bu was administered. This abnormal development may result from the destruction of the HERS. The administration of Bu caused a shortage of HERS cells, which are required for normal root development. This disturbs root formation, resulting in osteodentin formation and a narrowed apex foramen.
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Jesudas R, Malesky A, Chu R, Fischer H, Kamat D. Reviewing the follow-up care of pediatric patients' status post-hematopoietic stem cell transplantation for the primary care pediatrician. Clin Pediatr (Phila) 2013; 52:487-95. [PMID: 23564303 DOI: 10.1177/0009922813483361] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is a treatment modality for many oncologic as well as non-oncologic disorders. Although the side effects of different chemotherapy regimens have been well studied by several oncology consortiums, limited data is available regarding the late adverse effects of HSCT. Furthermore, pediatric-focused post-HSCT follow-up guidelines for primary care pediatricians do not exist. OBJECTIVE To provide a summary of the most common late adverse effects of HSCT and give the primary care pediatrician guidance and evidence-based information for the screening and management of this patient population. DESIGN The literature was searched using PubMed using keywords, including pediatric bone marrow transplant, hematopoietic stem cell transplant guidelines, pediatric bone marrow transplant guidelines, and pediatric bone marrow transplant immunizations. The most relevant articles out of the hundreds of results were reviewed. RESULTS Based on 9 review articles from the Pediatric Clinics of North America and 3 articles from the Biology of Blood and Marrow Transplant Journal as well as their original references, a summary of the most common late adverse effects after HSCT was constructed. Pediatric HSCT patients have a high incidence of late adverse effects, with 93% of survivors having at least 1 late adverse effect after 7 years of follow-up. CONCLUSION Late adverse effects after pediatric HSCT are common and require close screening and monitoring, which can be done by the primary care provider along with the oncologist.
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Affiliation(s)
- Rohith Jesudas
- Children's Hospital of Michigan, Detroit, MI 48201, USA.
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Abadie C, Lechaix B, Gandemer V, Bonnaure-Mallet M. Neuroblastoma and tooth abnormalities: a common history? Oral Oncol 2013; 49:e11-3. [PMID: 23352669 DOI: 10.1016/j.oraloncology.2012.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 12/20/2012] [Accepted: 12/23/2012] [Indexed: 10/27/2022]
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