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Pombo Lopes J, Rodrigues I, Machado V, Botelho J, Bandeira Lopes L. Chemotherapy and Radiotherapy Long-Term Adverse Effects on Oral Health of Childhood Cancer Survivors: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 16:110. [PMID: 38201538 PMCID: PMC10777916 DOI: 10.3390/cancers16010110] [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: 11/30/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The survival rate for pediatric cancer has increased over the past few decades, short- and long-term complications have been detected and studied, and oral complications have emerged as an important topic of research. Here, we aimed to highlight the importance of oral manifestations that may only become apparent years or even decades after cancer treatment. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We searched articles using PubMed via the MEDLINE, Web of Science, and LILACS databases until October 2023. Overall, 35 observational studies were included, and the results estimated a pooled prevalence of the following dental anomalies: discoloration, 53%; crown-root malformations and agenesis, 36%; enamel hypoplasia, 32%; root development alterations, 29%; unerupted teeth, 24%; microdontia, 16%; hypodontia, 13%; and macrodontia, 7%. Most childhood cancer survivors have at least one dental sequela. Childhood cancer survivors presented a higher risk of having dental alterations than control counterparts. Additional analyses reveal possible sex-based differences that should be explored in future studies. These results collectively highlight the importance of oral healthcare and the prevention of disease in childhood cancer survivors.
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Affiliation(s)
- Joana Pombo Lopes
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
| | - Inês Rodrigues
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
| | - Vanessa Machado
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - João Botelho
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
| | - Luísa Bandeira Lopes
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (J.P.L.); (I.R.); (V.M.); (J.B.)
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal
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Gingival health in children in the different phases of acute lymphoblastic leukemia. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2019. [DOI: 10.2478/cipms-2019-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Acute lymphoblastic leukemia (ALL), the most common type of leukemia in children, has diverse oral cavity complications. While periodontal alterations in such patients are widely known, there were no studies evaluating gingival health from the time of diagnosis to the remission phase. In our study, we, therefore, analysed the frequency of periodontal diseases and the gingival indices in the different phases of ALL in children. Children aged 7-15 years were involved into the cross-sectional study. Therein, 160 children with ALL were divided into three groups: L1 – 50 children examined before the initiation phase, L2 – 50 children examined after 1 month of the chemotherapy, L3 – 60 children examined in permanent hematologic remission. The control (HC) included 150 healthy children. The L1, L2 and L3 groups had significantly worse gingival indices and frequency of gingivitis than the HC group (p < 0.0001). Frequency of gingivitis increased from before the initiation to the remission phase, but significantly only in 7-11 year-old children (p = 0.0004). Gingival indices increased after 1 month of chemotherapy (p < 0.0001), but decreased in the permanent remission phase (p < 0.0001).
Our study stresses the need for children with ALL to not only require prevention courses before the initiation and during the chemotherapy phases, but also in the permanent remission phase to minimize the long-term impact of leukemia treatment on gingival health.
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Vandenbroucke T, Verheecke M, Fumagalli M, Lok C, Amant F. Effects of cancer treatment during pregnancy on fetal and child development. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:302-310. [PMID: 30169185 DOI: 10.1016/s2352-4642(17)30091-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 01/08/2023]
Abstract
It has become clear that, for specific cancers and under well defined circumstances, oncological treatment in pregnancy is possible. In this Review, we summarise the evidence on fetal, neonatal, short-term, and long-term effects of prenatal exposure to cancer treatment on the child. So far, outcomes of children are generally reassuring, but long-term follow-up is insufficient. The most important risks of chemotherapy during pregnancy are preterm birth and babies being small for gestational age. Chemotherapy in the first trimester is contraindicated because of an increased risk of congenital malformations. Studies on outcomes of children exposed to radiotherapy, targeted therapy, or hormonal therapy in pregnancy are scarce. Careful registration of women undergoing cancer treatment in pregnancy and long-term follow-up of their children are important. Comprehensive documentation of the mental and physical status of children exposed to cancer treatment in utero will allow physicians and parents to best decide whether to treat cancer during pregnancy.
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Affiliation(s)
- Tineke Vandenbroucke
- Department of Oncology, KU Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Magali Verheecke
- Department of Oncology, KU Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Christianne Lok
- Center Gynecologic Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Frédéric Amant
- Department of Oncology, KU Leuven-University of Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Center Gynecologic Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, Netherlands; Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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Bica C, Ion V, Mártha K, Esian D, Chinceșan M, Monea M. Original Research. The Evaluation of Caries Severity Index and Dental Hypoplasia in Children with Acute Lymphoblastic Leukemia. Results from a Romanian Medical Center. JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Acute lymphoblastic leukemia (ALL) is a type of cancer that most frequently affects children, and its treatment involves intensive chemotherapy, which might interfere with the normal development of dental tissues. The aim of our study was to measure the incidence of dental caries and enamel hypoplasia in children diagnosed with ALL treated according to the Berlin-Frankfurt-Munster-95 (ALL-BFM-95) protocol during the complete remission phase. Two groups of children between 8-12 years of age were investigated: Group 1 consisted of 36 children with ALL, and Group 2 of 58 control age-matched children. The decay-missing-filling index for the deciduous teeth (DMFT) and the presence of hypoplasia in the first permanent molars (MH) or in both incisors and molars (MIH) were recorded. The results were statistically analyzed and showed that there were no differences between the groups regarding the DMFT values (p >0.05), but there was a statistically significant difference in the incidence of MH and MIH between groups (p <0.05). According to our results, chemotherapy was not responsible for the decay process, as there were no differences in DMFT indices between the groups, but the high incidence of MH and MIH in the ALL group indicates the need of a good dental care for these children in order to prevent future dental complications.
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Affiliation(s)
- Cristina Bica
- Department of Pediatric Dentistry and Orthodontics, University of Medicine and Pharmacy, Str. Gheorghe Marinescu nr. 50, 540139, Tîrgu Mureş, Romania
| | - Valentin Ion
- Department of Analytical Chemistry and Drug Analysis, University of Medicine and Pharmacy, Str. Gheorghe Marinescu nr. 50, 540139, Tîrgu Mureş, Romania
| | - Krisztina Mártha
- Department of Pediatric Dentistry and Orthodontics, University of Medicine and Pharmacy, Str. Gheorghe Marinescu nr. 50, 540139, Tîrgu Mureş, Romania
| | - Daniela Esian
- Department of Pediatric Dentistry and Orthodontics, University of Medicine and Pharmacy, Str. Gheorghe Marinescu nr. 50 540139, Tîrgu Mureş, Romania
| | - Mihaela Chinceșan
- Department of Oncological Pediatrics, University of Medicine and Pharmacy, Str. Gheorghe Marinescu nr. 50, 540139, Tîrgu Mureş, Romania
| | - Monica Monea
- Department of Odontology and Oral Pathology, University of Medicine and Pharmacy, Str. Gheorghe Marinescu nr. 50, 540139, Tîrgu Mureş, Romania
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Chen CF, Wang RH, Cheng SN, Chang YC. Assessment of Chemotherapy-Induced Oral Complications in Children With Cancer. J Pediatr Oncol Nurs 2016; 21:33-9. [PMID: 15058405 DOI: 10.1177/1043454203259947] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To assess children with cancer for oral complications using the oral assessment guide (OAG) and ascertain the efficacy of an oral hygiene care regimen in children undergoing chemotherapy and at 1 to 2 weeks postchemotherapy administration.Methods: Thirty pediatric cancer patients with either leukemia or lymphoma were randomly selected from 3 medical centers. A quasi-experimental design was used to evaluate the difference between pre- and post-oral hygiene care. Descriptive and inferential statistical techniques were used to analyze the data. The interrater agreement between the nurse and the dentist was calculated using a Kappa score. A paired t test was to examine the difference between preand post-oral hygiene care regimen.Results: The OAG scores ranged from 8 to 24. The higher the score, the more severe the oral complications. Ninety-six percent of the participants had a score [. greaterequal] 9, on the pre-test, 26. 7% had an OAG score [. greaterequal] 12. Oral complications included ulcerated mucous membranes, dry lips, deeper or raspy voice, and oral debris. No scores were [. greaterequal] 12 on the OAG following the posttest. The oral hygiene care regimen significantly improved oral assessment among patients (P <. 05).Conclusions: The authors postulate that the OAG and oral hygiene care regimen may be clinically useful in improving oral assessment and hygiene in children with cancer during and after chemotherapy, thus decreasing associated infection and enhancing patient comfort.
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Affiliation(s)
- Chia-Feng Chen
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan.
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van Dommelen P, Schuller AA. The amount of care delivered: challenges of indices in oral health studies. Community Dent Oral Epidemiol 2016; 44:485-92. [PMID: 27167690 DOI: 10.1111/cdoe.12238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Untreated dental caries is the most prevalent medical condition worldwide, with considerable variations in prevalence between regions and countries. The care index (CI) and the restorative index (RI) are generally used to make comparisons between and within countries of levels of care delivered. However, several methodological challenges can be identified that limit the interpretation and comparison of these indices. The objective of this manuscript was to evaluate these challenges and to provide solutions. METHODS Five challenges were identified: (i) the comparability of CI and RI, (ii) the use of multiple definitions of CI and RI, (iii) CI and RI measured for surfaces or teeth, (iv) the skewness of F/D(M)F (restored teeth or surfaces as a fraction of the total number of decayed, (missing), and filled teeth or surfaces), and (v) the relationship between CI, RI and D(M)F. Time-series data were obtained - for people aged 25-44 years with low socioeconomic status - from four cross-sectional studies performed in 1995, 2002, 2007 and 2013 in the Netherlands, and those data were subjected to descriptive analyses. RESULTS The analyses showed that the choice of index and definition had a major impact on the results, which varied in terms of absolute size and trends. Moreover, CI and RI are expressed as mean scores, but the distributions of F/DMF and F/DF were highly skewed. CI and RI may therefore mask groups of individuals who still need care. The proportion of individuals receiving most restorative care was much higher in the group with low levels of caries than in the groups with more caries. This implies that, when the need for care decreases over time, the restorative care indices can be expected to increase, even though there may be no improvement in the amount of care delivered. CONCLUSIONS We argue that epidemiological studies of oral health in the future should clarify the definitions used to describe the care delivered and investigate subgroups of F/DMF or F/DF in categories based on the extent of caries. These figures could be used to monitor changes in treatment provision and to highlight inequalities in the provision of care.
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Affiliation(s)
| | - Annemarie A Schuller
- Department of Child Health, TNO, Leiden, The Netherlands.,Center for Dentistry and Oral Hygiene in Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Gupta A, Marwaha M, Bansal K, Sachdeva A, Gupta A. Dental Awareness among Parents and Oral Health of Paediatric Cancer Patients Receiving Chemotherapy. J Clin Diagn Res 2016; 10:ZC92-5. [PMID: 27437369 DOI: 10.7860/jcdr/2016/17412.7819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/17/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Dental care is often overlooked by the parents of children receiving treatment for cancer including chemotherapy who are in a phase of severe immunosuppression. AIM (i) To study dental attitudes of parents of children receiving chemotherapy towards importance of dental care. (ii) To evaluate oral hygiene status and compare it with healthy controls. MATERIALS AND METHODS A questionnaire assessing the awareness towards dental care was given to the parents of 47 paediatric patients suffering from cancer receiving chemotherapy and to parents of 47 paediatric patients reporting to outpatient Department of Pedodontics at SGT Dental College. Oral examination was also carried out for both the groups and DMFT/dmft, plaque and gingival index were noted. RESULTS Parents had a varying opinion regarding dental health of their child. The caries status of children in the control group was greater than children in the study group. The mean plaque index of children in the control group (1.40) was greater than children in the study group (1.34) which was statistically significant according to Mann-Whitney U test. The gingival health of children in the study group was better than children in the control group which was also not statistically significant. CONCLUSION This study highlights need for a periodic referral of the child cancer patients to the paediatric dental clinic in hospitals for the timely dental care.
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Affiliation(s)
- Aarushi Gupta
- Postgraduate Student, Department of Pedodontics & Preventive Dentistry, Faculty of Dental Sciences, SGT University Budhera, Gurgaon, Haryana, India
| | - Mohita Marwaha
- Reader, Department of Pedodontics & Preventive Dentistry, Faculty of Dental Sciences, SGT University , Budhera, Gurgaon, Haryana, India
| | - Kalpana Bansal
- Assistant Professor, Department of Pedodontics & Preventive Dentistry, AIIMS , New Delhi, India
| | - Anupam Sachdeva
- Consultant and Head, Department of Paediatric Haemato- Oncology, Sir Gangaram Hospital , New Delhi, India
| | - Ajay Gupta
- Consultant and Head, Department of Radiotherapy, Vardhman Mahavir Medical College and Safdarjung Hospital , New Delhi, India
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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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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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Abstract
Leukemia is one of the most common malignancies affecting children in India. These children usually suffer from various oral complications, which may be due to the leukemia or due to the chemotherapeutic agents and/or radiotherapy. The complications may include some of the opportunistic infections like candidiasis, herpes simplex; hemorrhage, mucositis, taste alterations and increased incidence of dental caries etc. These complications can cause significant morbidity and mortality in the patients. The aim of this review is to summarize the various oral complications in these children and the methods of prevention and management.
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Affiliation(s)
- Vijay Prakash Mathur
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Hong CHL, Napeñas JJ, Hodgson BD, Stokman MA, Mathers-Stauffer V, Elting LS, Spijkervet FKL, Brennan MT. A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer 2010; 18:1007-21. [PMID: 20449756 PMCID: PMC2914291 DOI: 10.1007/s00520-010-0873-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 03/29/2010] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This purpose of this systematic review was to evaluate the literature and update our current understanding of the impact of present cancer therapies on the dental apparatus (teeth and periodontium) since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies. REVIEW METHOD A systematic literature search was conducted with assistance from a research librarian in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 1990 and 31 December 2008. Each study was independently assessed by two reviewers. Taking into account predetermined quality measures, a weighted prevalence was calculated for the prevalence of dental caries, severe gingival disease, and dental infection. Data on DMFT/dmft, DMFS/dmfs, plaque, and gingival indexes were also gathered. The level of evidence, recommendation, and guideline (if possible) were given for published preventive and management strategies. RESULTS Sixty-four published papers between 1990 and 2008 were reviewed. The weighted overall prevalence of dental caries was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (SD, 7.98; n = 457). The overall plaque index for patients who were post-antineoplastic therapy was 1.38 (SD, 0.25; n = 189). The GI for patients who were post-chemotherapy was 1.02 (SD, 0.15; n = 162). The weighted prevalence of dental infections/abscess during chemotherapy was reported in three studies and was 5.8%. CONCLUSIONS Patients who were post-radiotherapy had the highest DMFT. The use of fluoride products and chlorhexidine rinses are beneficial in patients who are post-radiotherapy. There continues to be lack of clinical studies on the extent and severity of dental disease that are associated with infectious complications during cancer therapy.
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Affiliation(s)
- Catherine H. L. Hong
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
| | - Joel J. Napeñas
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
| | - Brian D. Hodgson
- Program in Pediatric Dentistry, Department of Developmental Sciences, Marquette University School of Dentistry, 1801 W. Wisconsin Ave, Milwaukee, WI 53233 USA
| | - Monique A. Stokman
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | | | - Linda S. Elting
- The University of Texas M.D. Anderson Cancer Centre, P.O. Box 301402, Houston, TX 77230-1402 USA
| | - Fred K. L. Spijkervet
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RG Groningen, The Netherlands
| | - Michael T. Brennan
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
| | - Dental Disease Section, Oral Care Study Group, Multi-national Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO)
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, P.O. Box 32861, Charlotte, NC 28232 USA
- Program in Pediatric Dentistry, Department of Developmental Sciences, Marquette University School of Dentistry, 1801 W. Wisconsin Ave, Milwaukee, WI 53233 USA
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Penrose Cancer Center, 2222 North Nevada Avenue, Colorado Springs, CO 80907 USA
- The University of Texas M.D. Anderson Cancer Centre, P.O. Box 301402, Houston, TX 77230-1402 USA
- Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RG Groningen, The Netherlands
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Cubukçu CE, Sevinir B. Dental health indices of long-term childhood cancer survivors who had oral supervision during treatment: a case-control study. Pediatr Hematol Oncol 2008; 25:638-46. [PMID: 18850476 DOI: 10.1080/08880010802237849] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this case-control study was to compare the dental health of a group of long-term survivors of childhood cancer with that of age- and gender-matched healthy controls. All children who had been progress- and/or disease-free for at least 5 years were selected. Caries indices for permanent dentition (DMF/T) and primary dentition (dmf/t) were calculated. Past data were collected from medical and dental records and read separately by one of the authors. The mean age of the subjects at the initial diagnosis of the disease was 4.3 +/- 0.3 yr (range 0.5-14 yr). The mean time lapse from the cessation of the therapy to the present dental examination was 5.0 +/- 0.7 yr. The study group had significantly (p < .001) more carious lesions in their primary teeth than the control group. The mean dmf/t value was 5.8 +/- 0.6 in the long-term survivors compared to 3.4 +/- 0.2 in the controls. The difference in DMF/T value of those children was statistically insignificant (p > .05) compared to healthy subjects (2.1 +/- 0.6 and 1.6 +/- 0.2, respectively). There was a significant positive correlation between the presence of head and neck radiotherapy (r = 0.427, p < .05), the number of months the child had been on chemotherapy (r = 0.413, p < .01), the number of fluoride gel treatments (r = .361, p < .05), and dmf/t values, separately. Based on the results of this study, our Unit now considers a through semiannual dental examination for every child who will be or has been treated at Pediatric Oncology Department to be mandatory. The focus should be on caries prevention and include dietary counseling, oral hygiene, and fluoride applications if necessary.
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Affiliation(s)
- Ciğdem Elbek Cubukçu
- Pediatric Dental Care Unit, Faculty of Medicine, Uludag University, Bursa, Turkey.
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Wogelius P, Dahllöf G, Gorst-Rasmussen A, Sørensen HT, Rosthøj S, Poulsen S. A population-based observational study of dental caries among survivors of childhood cancer. Pediatr Blood Cancer 2008; 50:1221-6. [PMID: 18273868 DOI: 10.1002/pbc.21464] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The few published studies on caries among childhood cancer survivors are small and their results are conflicting. The study aim was to examine the risk of dental caries among children who have survived cancer. PROCEDURE We included 299,426 7-year-old, 313,461 12-year-old, and 301,930 15-year-old children born between 1984 and 1988 in a nationwide population-based study linking records from Danish Cancer Registry with records from the national database on oral health. Children whose dental examinations had been preceded by a cancer diagnosis (288 7-year-old, 459 12-year-old, and 526 15-year-old) were compared with children without cancer according to presence of caries: caries-free children; children with any caries experience; and children with severe caries experience (i.e., caries in one or more smooth tooth surface). RESULTS Children diagnosed with cancer before the age of 5 years did not have increased caries prevalence in permanent teeth at ages 12; and 15. Children diagnosed with cancer between 5 and 6 years of age had an increased prevalence of severe caries at age 12 years (prevalence ratio (PR) = 1.59 (95% CI: 1.09-2.31; P = 0.02)), but this difference disappeared by age 15. For children diagnosed with cancer at 5 or 6 years of age and who received radiation therapy the PR of severe caries was 1.52 (95% CI: 0.97-2.37; P = 0.07), 2.13 (95% CI: 0.89-5.10; P = 0.09), and 0.31 (95% CI: 0.07-1.45; P = 0.13) at ages seven, 12 and 15 years respectively. CONCLUSION Cancer and cancer treatment during childhood are risk factors for caries.
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Affiliation(s)
- Pia Wogelius
- Department of Community Oral Health and Pediatric Dentistry, School of Dentistry, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.
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Abstract
The past 3 decades have seen tremendous improvements in the survival of children diagnosed with cancer, with the 5-year survival rate approaching 80%. This improvement in survival has resulted in a growing population of childhood cancer survivors. Use of cancer therapy at an early age can produce complications that may not become apparent until years later. Approximately two thirds of the survivors of childhood cancer experience at least one late effect and about one fourth experience a late effect that is severe or life-threatening, although psychosocial issues in survivors and family members are often underestimated and may be more prevalent. Long-term complications in childhood cancer survivors, such as impairment in growth and development, neurocognitive dysfunction, cardiopulmonary compromise, endocrine dysfunction, renal impairment, gastrointestinal dysfunction, musculoskeletal sequelae, and subsequent malignancies, are related not only to the specific therapy used but also may be determined by individual host characteristics. We review the known late effects in survivors of childhood in order to suggest reasonable starting points for the evaluation of specific long-term problems in this unique but growing population.
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Affiliation(s)
- Smita Bhatia
- Division of Pediatric Hematology-Oncology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, California 91010, USA.
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15
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Yeazel MW, Gurney JG, Oeffinger KC, Mitby PA, Mertens AC, Hudson MM, Robison LL. An examination of the dental utilization practices of adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Public Health Dent 2004; 64:50-4. [PMID: 15078062 DOI: 10.1111/j.1752-7325.2004.tb02726.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study characterized the self-reported dental utilization practice of long-term survivors of childhood cancer, a group at increased risk for treatment-induced dental abnormalities. METHODS 9,434 survivors and a comparison group of 3,858 siblings completed a 289-item survey that included a question on when their last dental visit occurred. RESULTS Within the last year 60.4 percent of survivors reported a dental visit. The groups less likely to report a recent dental visit include minority subjects, subjects with low levels of educational attainment, subjects with annual household incomes < dollar 20,000, and those without health insurance. No significant differences between survivors and siblings were seen. Male survivors exposed to cranial radiation were slightly more likely than other male survivors to report a recent dental visit (OR = 1.27, 95% CI = 1.12, 1.44). CONCLUSIONS The dental utilization practices among survivors of childhood cancer are below recommended levels, even among those at highest risk for dental abnormalities.
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Affiliation(s)
- Mark W Yeazel
- University of Minnesota Medical School, Department of Family Practice and Community Health, Mayo Medical Code 381, 420 Delaware Street, SE, Minneapolis, MN 55455, USA.
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16
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Costa EMMDB, Fernandes MZ, Quinder LB, de Souza LB, Pinto LP. Evaluation of an oral preventive protocol in children with acute lymphoblastic leukemia. ACTA ACUST UNITED AC 2003; 17:147-50. [PMID: 14569357 DOI: 10.1590/s1517-74912003000200009] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study was designed to assess the effectiveness of a preventive oral protocol in children receiving antineoplastic treatment for acute lymphoblastic leukemia (ALL) before initiating a larger intervention study. During a seven month period, fourteen children from two to ten years old with a diagnosis of ALL were evaluated. Patients with ALL who received a 0.12% chlorhexidine mouth rinse (seven children) were compared to a control group of patients who were not given the same preventive treatment (seven children) as to the occurrence of oral mucosal complications. Children in both groups received daily oral hygiene care, and were examined daily by the pediatric dentistry team until discharge. A significant decrease in the incidence of oral mucositis and ulceration was observed in the children who received a 0.12% chlorhexidine mouth rinse (p < 0.05 by Fisher's exact test). The findings obtained in the present trial are encouraging, and suggest that the systematic application of a preventive protocol reduces the incidence of oral complications in children with ALL receiving chemotherapy.
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17
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Pomarico L, de Souza IP, Tura LF. Oral health profile of education and health professionals attending handicapped children. PESQUISA ODONTOLOGICA BRASILEIRA = BRAZILIAN ORAL RESEARCH 2003; 17:11-6. [PMID: 12908053 DOI: 10.1590/s1517-74912003000100003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to evaluate the knowledge and attitudes toward oral health of education and health professionals working in a children care program for handicapped children from 0 to 6 years of age, run by a public municipal institution in Rio de Janeiro. Using a printed questionnaire, 67 professionals (teachers, attendants and health professionals) were interviewed. The results were compared to the children's oral hygiene habits, by directly observing their daily nursery routine. Although 97.0% said that oral health could play a part in general health, only 37.3% of the professionals answered correctly on this matter. As for methods for preventing caries, although 92.5% said that they were aware of them, only 17.9% went to the dentist for preventive treatment. Although the majority (81.3%) indicated oral hygiene as a way of preventing caries, observation showed that this practice is not always put into effect in the program's day nursery. Regarding when to start toothbrushing in children, 75.0% of the teachers and 94.4% of the health professionals said that they were aware of the need to begin brushing before one year of age, although this reply was given by only 52.5% of the attendants (chi-square, p = 0.006). In view of these results, it was concluded that attitudes toward oral health were not always coherent with the knowledge that these professionals express.
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Affiliation(s)
- Luciana Pomarico
- Center for Studies in Public Health-Federal University of Rio de Janeiro
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18
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Affiliation(s)
- Alison D Leiper
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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19
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Dahllöf G, Jönsson A, Ulmner M, Huggare J. Orthodontic treatment in long-term survivors after pediatric bone marrow transplantation. Am J Orthod Dentofacial Orthop 2001; 120:459-65. [PMID: 11709663 DOI: 10.1067/mod.2001.118102] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Children treated for childhood cancers with both radiation and chemotherapy often exhibit disturbances in dental development. A retrospective analysis of treatment outcome in 10 orthodontically treated children was performed. A questionnaire was sent to each child's orthodontist, and 5 orthodontists reported that the patient's medical condition influenced their choice of treatment plan. Three orthodontists, all treating patients with severely disturbed root development, reported using lighter forces than they used with the average patient. With regard to complications related to orthodontic treatment, 1 of the 10 patients showed evidence of root resorption. In 4 of the 10 patients, the treatment result was judged to be unsatisfactory. This study showed that, although ideal treatment results were not always achieved, orthodontic treatment did not produce any harmful side effects in children who are long-term survivors of childhood cancer.
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Affiliation(s)
- G Dahllöf
- School of Dentistry, Karolinska Institutet, Stockholm, Sweden.
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20
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Parry JA, Khan FA. Provision of dental care for medically compromised children in the UK by General Dental Practitioners. Int J Paediatr Dent 2000; 10:322-7. [PMID: 11310246 DOI: 10.1046/j.1365-263x.2000.00207.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to investigate the views of General Dental Practitioners (GDPs) regarding their provision of dental treatment for medically compromised children. A questionnaire to assess confidence, experience and willingness to treat eight specific groups of medically compromised children was sent to 524 GDPs. Information is based on 271 completed questionnaires. The median number of children treated by GDPs in each of the eight groups over the previous 5 years was 0-2. Eighty percent of respondents stated that they would value further training in the provision of dental care for medically compromised children. Confidence was highest in providing dental treatment for children with three conditions: congenital heart disease (37% very confident), diabetes (39% very confident) and epilepsy (41% very confident). These were also the conditions that the GDPs reported as presenting most frequently in the dental surgery. GDPs reported least confidence in providing dental care for children with haemophilia (12% very confident) and organ transplants (14% very confident). Only 30% of GDPs wanted to be routinely involved with the provision of dental care for medically compromised children. The results indicate that medically compromised children may have problems accessing dental care and expertise. A system of integrated medical and specialised dental care is suggested.
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Affiliation(s)
- J A Parry
- GKT, Department of Paediatric Dentistry, Guy's Hospital, St. Thomas Street, London SE1, UK
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21
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Duggal MS, Curzon ME, Bailey CC, Lewis IJ, Prendergast M. Dental parameters in the long-term survivors of childhood cancer compared with siblings. Oral Oncol 1997; 33:348-53. [PMID: 9415335 DOI: 10.1016/s1368-8375(97)89103-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There have been a number of reports on the dental health of long-term survivors (LTS) of childhood malignancy as compared with normal controls. However, it is usually difficult to identify a meaningful control population as most of these patients are from widely differing geographical areas and socio-economic status. The aim of this investigation was, therefore, to study the dental health of LTS compared with siblings. 46 LTS who had siblings of a similar age were identified for the study. Both groups were examined for dental caries, gingivitis and enamel defects. There was no statistically significant difference in the mean DMFS of the test and control groups. However, the LTS had a significantly (P = 0.006) higher number of decayed surfaces (1.50 +/- 0.30) as compared with their siblings (0.50 +/- 0.20). The LTS also had a significantly higher prevalence of severe gingivitis (1.11 +/- 0.33) compared with controls (0.02 +/- 0.02). There was a significantly higher prevalence of all types of enamel defects in the LTS and fewer teeth with no enamel defect as compared with their siblings, with the mean values being 15.7 +/- 0.9 and 25.3 +/- 0.3, respectively. It was concluded that there was a higher prevalence of untreated dental disease and developmental defects in long-term survivors.
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Affiliation(s)
- M S Duggal
- Division of Child Dental Health, Leeds Dental Institute, U.K
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Dens F, Boute P, Vinckier F, Declerck D. Quantitative determination of immunologic components of salivary gland secretion in long-term, event-free pediatric oncology patients. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1995; 79:701-4. [PMID: 7621026 DOI: 10.1016/s1079-2104(05)80303-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Chemotherapy influences the human immune system. Salivary alterations occur during cancer treatment. In this article we examine the salivary immunoglobulin content in pediatric patients who were long-term event-free and correlate these findings with different oral factors. STUDY DESIGN Fifty-two children of a study group and 63 children of a control group were examined at our University Hospital. Caries prevalence and plaque index were scored. Whole saliva samples were taken for determination of slgA and IgG concentrations and Streptococcus mutans and Lactobacillus counts. For statistical analysis the Dental Survey Plus (Providence Software Services, Bristol, England) software package was used. RESULTS Concentrations of slgA and IgG were within normal limits in both groups; slgA level increased with age. A negative correlation between slgA concentration and caries experience was not found in all age groups. No correlation with other salivary parameters was found. CONCLUSION Salivary content of slgA and IgG can return to normal after cytotoxic therapy in these children. Salivary IgA seem to play a role in the development of dental caries in this population.
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Affiliation(s)
- F Dens
- Department of Dentistry, Free University of Brussels, Belgium
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