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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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Akitomo T, Ogawa M, Kaneki A, Nishimura T, Usuda M, Kametani M, Kusaka S, Asao Y, Iwamoto Y, Tachikake M, Mitsuhata C, Nomura R. Dental Abnormalities in Pediatric Patients Receiving Chemotherapy. J Clin Med 2024; 13:2877. [PMID: 38792419 PMCID: PMC11122590 DOI: 10.3390/jcm13102877] [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: 04/08/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Chemotherapy is a common treatment for pediatric cancer. Although life prognosis is improving because of advances in medical science, it is important to deal with late effects such as dental abnormalities. We investigated the association between dental abnormalities and chemotherapy by age and tooth type. Methods: Among the 568 patients referred to the pediatric dentistry department of our hospital, we selected 32 patients (21 male and 11 female) who received chemotherapy between the ages of 0 and 6 and underwent panoramic examination after the age of 7. We recorded the age of chemotherapy commencement, diagnosis of systemic disease, and dental abnormalities such as congenital absence, microdonts, and short-rooted teeth. Results: Almost half of the patients had dental abnormalities such as congenital absence, microdonts, and short-rooted teeth, but there were no significant differences in the incidence of these abnormalities by age. When we analyzed the incidence of abnormal teeth by tooth type, the incidence of congenital absence was significantly higher in premolars (5.5%) and second molars (3.9%) than in incisor or canine or 1st molar (0.4%) (p < 0.01). The incidence of microdonts was significantly higher in premolars (3.9%) than in incisor or canine or 1st molar (0.2%) and second molars (0.0%) (p < 0.05). Conclusions: Patients who received chemotherapy had a high prevalence of dental abnormalities, and the incidence of abnormalities varied by tooth type. It is important to maintain long-term oral care for patients who have undergone chemotherapy even after the treatment is completed.
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Affiliation(s)
- Tatsuya Akitomo
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (A.K.); (T.N.); (M.U.); (M.K.); (S.K.); (Y.A.); (Y.I.); (C.M.); (R.N.)
| | - Masashi Ogawa
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (A.K.); (T.N.); (M.U.); (M.K.); (S.K.); (Y.A.); (Y.I.); (C.M.); (R.N.)
| | - Ami Kaneki
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (A.K.); (T.N.); (M.U.); (M.K.); (S.K.); (Y.A.); (Y.I.); (C.M.); (R.N.)
| | - Taku Nishimura
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (A.K.); (T.N.); (M.U.); (M.K.); (S.K.); (Y.A.); (Y.I.); (C.M.); (R.N.)
| | - Momoko Usuda
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (A.K.); (T.N.); (M.U.); (M.K.); (S.K.); (Y.A.); (Y.I.); (C.M.); (R.N.)
| | - Mariko Kametani
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (A.K.); (T.N.); (M.U.); (M.K.); (S.K.); (Y.A.); (Y.I.); (C.M.); (R.N.)
| | - Satoru Kusaka
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (A.K.); (T.N.); (M.U.); (M.K.); (S.K.); (Y.A.); (Y.I.); (C.M.); (R.N.)
| | - Yuria Asao
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (A.K.); (T.N.); (M.U.); (M.K.); (S.K.); (Y.A.); (Y.I.); (C.M.); (R.N.)
| | - Yuko Iwamoto
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (A.K.); (T.N.); (M.U.); (M.K.); (S.K.); (Y.A.); (Y.I.); (C.M.); (R.N.)
| | - Meiko Tachikake
- Department of Pediatric Dentistry, Hiroshima University Hospital, Hiroshima 734-8551, Japan;
| | - Chieko Mitsuhata
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (A.K.); (T.N.); (M.U.); (M.K.); (S.K.); (Y.A.); (Y.I.); (C.M.); (R.N.)
| | - Ryota Nomura
- Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (M.O.); (A.K.); (T.N.); (M.U.); (M.K.); (S.K.); (Y.A.); (Y.I.); (C.M.); (R.N.)
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Rabassa-Blanco J, Brunet-Llobet L, Marcote-Sinclair P, Balsells-Mejía S, Correa-Llano MG, Miranda-Rius J. Prevalence of, and risk factors for, dental sequelae in adolescents who underwent cancer therapy during childhood. Oral Dis 2024; 30:604-614. [PMID: 35841375 DOI: 10.1111/odi.14317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The increase in survival rates in children treated for cancer has been accompanied by a rise in sequelae in permanent teeth. The aim of the study was to correlate the type of cancer therapy administered to patients during early childhood and the dental sequelae recorded in survivors. MATERIAL AND METHODS Single-center retrospective cohort study carried out at the Children's University Hospital of Sant Joan de Déu in Barcelona, Spain. Hundred and nine patients who had received cancer treatment during early childhood were randomly examined and grouped according to diagnosis and cancer therapy received. The type of therapy was correlated with the number and severity of dental lesions that patients presented in adolescence. RESULTS Dental sequelae of some kind were present in 85.3% of patients. Microdontia was the most prevalent (52.3%). Treatment with alkylating agents had a relative risk of presenting moderate lesions of 3.36 (1.18-9.60), and one of 2.29 (1.07-4.91) of presenting severe lesions. Topoisomerase inhibitors and cytotoxic antibiotics presented relative risks of 1.6 (1.07-2.38) and 2.08 (1.02-4.26) of root alterations and agenesis, respectively. CONCLUSIONS Treatment with alkylating agents together with cytotoxic antibiotics and topoisomerase inhibitors was associated with a higher relative risk of microdontia, agenesis, and root shortening.
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Affiliation(s)
- Judit Rabassa-Blanco
- Department of Pediatric Dentistry, Hospital Sant Joan de Déu (HSJD), University of Barcelona, Barcelona, Spain
- Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Lluís Brunet-Llobet
- Department of Pediatric Dentistry, Hospital Sant Joan de Déu (HSJD), University of Barcelona, Barcelona, Spain
- Hospital Dentistry, Clinical Orthodontics, and Periodontal Medicine Research Group (HDCORPEMrg), Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
| | - Paula Marcote-Sinclair
- Department of Pediatric Oncology, Developmental Cancer Survivors Unit, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain
| | - Sol Balsells-Mejía
- Department of Research Promotion and Management. Statistical Support, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain
| | | | - Jaume Miranda-Rius
- Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Hospital Dentistry, Clinical Orthodontics, and Periodontal Medicine Research Group (HDCORPEMrg), Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
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Presentation of a Case of Short Root Anomaly in an 11-Year-Old Child. Case Rep Dent 2023; 2023:1766133. [PMID: 36643592 PMCID: PMC9833915 DOI: 10.1155/2023/1766133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Short root anomaly (SRA) is a developmental anomaly in which the affected teeth present morphologically normal crowns and short, round roots. The exact cause of SRA is unknown. A case of an 11-year-old female patient with SRA is described. The patient presented short, round roots of all permanent teeth but first molars. Maxillary lateral incisors presented severe root resorption and mobility. Treatment plan included preservation of the maxillary lateral incisors by splinting them to their adjacent teeth using a stainless steel coaxial wire. A custom mouthguard for dental trauma protection was also constructed using a computer-aided design - computer-aided manufacturing (CAD-CAM) system in order to fabricate 3D-printed dental casts. At 2-year follow-up, the mobility of maxillary lateral incisors decreased, and the patient's dentition remained stable. Considerations regarding differential diagnosis, orthodontic management, and treatment options after an eventual loss of teeth are thoroughly discussed.
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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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6
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Bousserouit M, Benjelloune L, Chbicheb S. Late dental effects in children submitted to chemotherapy: A case report. Ann Med Surg (Lond) 2022; 84:104845. [PMID: 36582914 PMCID: PMC9793133 DOI: 10.1016/j.amsu.2022.104845] [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: 09/04/2022] [Revised: 10/24/2022] [Accepted: 10/30/2022] [Indexed: 11/21/2022] Open
Abstract
Chemotherapy may have many effects on teeth such a microdontia, hypoplasia and V shaped roots. The incidence and severity of dental abnormalities depend on the age at the diagnosis, the type of chemotherapeutic agent used. Therefore, it is important that general and pediatric dentists be aware of the late adverse effects of cancer therapy in children, especially in the oral cavity. This article intends to document a case illustrating different dental anomalies secondary to chemotherapy in 20 years old boy who had a history of chemotherapy in childhood.
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Affiliation(s)
- M. Bousserouit
- Oral Surgery Resident, Oral Surgery Department, Faculty of Dental Medicine-Rabat, Mohammed V University of Rabat, Morocco,Corresponding author. Faculty of dentistry, BP 6212, Madinat Al Irfane, Rabat, Morocco.
| | - L. Benjelloune
- Oral Surgery Department, Faculty of Dental Medicine-Rabat, Mohammed V University of Rabat, Morocco
| | - S. Chbicheb
- Oral Surgery Department, Faculty of Dental Medicine-Rabat, Mohammed V University of Rabat, Morocco
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7
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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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Baba R, Sato A, Arai K. Consecutive tooth agenesis patterns in non-syndromic oligodontia. Odontology 2021; 110:183-192. [PMID: 34236541 DOI: 10.1007/s10266-021-00634-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
Agenesis of two or more consecutive adjacent permanent teeth (consecutive tooth agenesis, CTA) is a serious manifestation of oligodontia requiring long-term, multi-disciplinary treatment. Therefore, the present study investigated the characteristics of the CTA pattern in orthodontic patients with non-syndromic oligodontia. Using panoramic radiographs, the number of agenetic permanent teeth excluding third molars in non-syndromic orthodontic patients was evaluated, and patients with six or more agenetic teeth (oligodontia group, n = 97) and with one to five agenetic teeth (hypodontia group, n = 107) were selected. The numbers of CTA including third molars in each quadrant and in each patient were compared between the groups. Each quadrant with CTA of patients was categorized into one of the following four types: (I) involves anterior teeth only; (II) involves posterior teeth only; (IIIA) includes anterior and posterior teeth; and (IIIB) separate in the anterior and posterior teeth. CTA in at least one quadrant was found in 91.8 and 4.7% of patients in the oligodontia and hypodontia groups, respectively. The highest frequency CTA patterns included agenesis of the first and second premolars and of the second and third molars in the oligodontia and hypodontia groups, respectively. In the oligodontia group, type IIIA was significantly more frequent in the maxillary than in the mandibular quadrant. Most oligodontia patients who visit orthodontic clinics have CTA. A rare but severe CTA pattern that continues from the anterior to posterior segments is more frequent in the maxillary than in the mandibular quadrant.
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Affiliation(s)
- Ryuichi Baba
- Department of Orthodontics, School of Life Dentistry At Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan
| | - Ayaka Sato
- Department of Orthodontics, School of Life Dentistry At Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan
| | - Kazuhito Arai
- Department of Orthodontics, School of Life Dentistry At Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan.
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Frascino AV, Fava M, Collassanti MDS, Odone-Filho V. Impact of Pediatric Hematopoietic Stem-Cell Transplantation on Craniofacial Growth. Clinics (Sao Paulo) 2020; 75:e1901. [PMID: 33146356 PMCID: PMC7561059 DOI: 10.6061/clinics/2020/e1901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/03/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess the craniofacial skeletal growth in pediatric hematopoietic stem-cell transplantation (HSCT) survivors in comparison with age-sex matched-paired controls. METHODS A case-controlled retrospective comparison of the craniofacial growth in 25 HSCT children and 25 matched-paired controls was conducted. Craniofacial growth was quantitatively assessed by linear and angular measurements in panoramic radiographic images using ImageJ¯. Stature growth and body weight were obtained through physical examination. Cancer diagnosis, myeloablative conditioning, and HSCT were retrieved from medical records. RESULTS Patients aged 12.2 years (±3.8; 16 male, 9 female). Radiographic images were obtained on an average of 2.43 (±2.0) years after HSCT. The main malignant diagnosis was acute lymphoblastic leukemia (56%), followed by acute myeloid leukemia (36%) and myelodysplastic syndromes (8%). Total body irradiation was associated with chemotherapy at 80%. Mean age at transplantation was 10 (±4.7) years. HSCT survivors showed reduced a vertical growth of the mandibular ramus (p=0.003). This persisted among individuals below 12 years of age (p=0.017). The HSCT group showed delayed dental eruption, though there was no statistically significant difference (p=0.3668). The HSCT group showed stature deficit, increased weight, and body mass index (Z-score stature: -0.28; Z-score weight: 0.38, respectively). CONCLUSIONS Pediatric HSCT has decreased vertical craniofacial growth compared to their matched controls. There might be an association between reduced craniofacial vertical growth and reduced estature growth. Further studies to quantitatively investigate the impact of different myeloablative regimens in craniofacial skeletal growth and development.
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Affiliation(s)
- Alexandre Viana Frascino
- Instituto da Crianca (ICr), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Marcelo Fava
- Instituto de Ciencias Tecnologicas (ICT), Universidade Estadual de Sao Paulo (UNESP), Sao Jose dos Campos, SP, BR
| | | | - Vicente Odone-Filho
- Instituto da Crianca (ICr), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
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Sato A, Arai K. Estimation of tooth agenesis risks between tooth types in orthodontic patients with non-syndromic oligodontia. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.odw.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Kazuhito Arai
- Department of Orthodontics, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan
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11
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Arai K. Tooth agenesis patterns in Japanese orthodontic patients with nonsyndromic oligodontia. Am J Orthod Dentofacial Orthop 2019; 156:238-247. [DOI: 10.1016/j.ajodo.2018.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 09/01/2018] [Accepted: 09/01/2018] [Indexed: 12/31/2022]
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12
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Poon LHJ, Yu CP, Peng L, Ewig CLY, Zhang H, Li CK, Cheung YT. Clinical ascertainment of health outcomes in Asian survivors of childhood cancer: a systematic review. J Cancer Surviv 2019; 13:374-396. [PMID: 31055708 PMCID: PMC6548762 DOI: 10.1007/s11764-019-00759-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/05/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Survivorship in children with cancer comes at a cost of developing chronic treatment-related complications. Yet, it is still an under-researched area in Asia, which shares the largest proportion of the global childhood cancer burden given its vast population. This systematic review summarizes existing literature on clinically ascertained health outcomes in Asian survivors of childhood cancer. METHODS A search was conducted on Ovid Medline and EMBASE for studies that focused on survivors of childhood cancer from countries in East and Southeast Asia; adopted post-treatment clinical ascertainment of organ-specific toxicities or/and secondary malignancy. Studies were excluded if health outcomes were assessed during the acute treatment. RESULTS Fifty-nine studies, enrolling a total of 13,442 subjects, were conducted on survivors of leukemia (34%), CNS tumor (14%), and cohorts of survivors with heterogeneous cancer diagnoses (52%). The studies used different medical evaluation methods to assess cardiovascular (15%), metabolic and infertility (32%), and neurological/neurocognitive (20%) outcomes in survivors. The collective findings suggest potential differences in the prevalence of certain late effects (e.g., secondary malignancy and obesity) among Asian and non-Asian populations, which may reflect differences in treatment regimens, practice, genetic variations, or/and socioeconomic disparity. CONCLUSIONS We recommend developing collaborative initiatives to build a regional repository of systematically assessed health outcomes and biospecimens to investigate treatment, social-environmental and genetic predictors, and interventions for late effects in this population. IMPLICATIONS FOR CANCER SURVIVORS The existing types of chronic health problems identified in this review suggest the need for active screening, better access to survivorship care, and promotion of protective health behavior in Asia.
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Affiliation(s)
- Long Hin Jonathan Poon
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, N.T, Hong Kong
| | - Chun-Pong Yu
- Li Ping Medical Library, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Liwen Peng
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, N.T, Hong Kong
| | - Celeste Lom-Ying Ewig
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, N.T, Hong Kong
| | - Hui Zhang
- Department of Pediatric Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Chi-Kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Paediatric Haematology & Oncology, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, N.T, Hong Kong.
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13
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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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14
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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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15
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Flores AP, Monti CF, Brunotto M. Dental and chronological age in children under oncological treatment. J Forensic Sci 2015; 60:453-6. [PMID: 25572724 DOI: 10.1111/1556-4029.12678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 03/23/2014] [Accepted: 03/28/2014] [Indexed: 11/28/2022]
Abstract
The current oncology treatment has improved the survival of children with several types of cancer, and the effect of radiotherapy and/or chemotherapy treatment on dental maturation in comparison with chronological age is not widely known. The aim of this work was to evaluate and compare the impact of radiotherapy and/or chemotherapy treatment during dental maturation with chronological age in Chilean children diagnosed with cancer. Study Design was cross-sectional study on children diagnosed with different types of cancer and treated with radiotherapy and/or chemotherapy when they were ages of 0.1 to 13 years. Demirjian tables for both girls and boys are used to determine the dental age. The association between chronological and dental age was highly significant. Nevertheless, a linear relation between chronological and dental age was not observed when the data were stratified by BMI and type of treatment. This study confirmed that dental age is an indicator of chronological age but that other variables, such as body mass index, in children with cancer could be confounder variables. Thus, further studies are necessary to investigate the influence of BMI on tooth eruption/maturation in children under oncological treatment.
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Affiliation(s)
- Antonieta Pérez Flores
- Department of Pediatric Dentistry, School of Dentistry, University of Concepción, Av Roosvelt 1550 Box Mail 160-C, Concepción, Chile
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