Effects of radiation on the developing dentition and supporting bone

Tooth eruption without roots

Root development and tooth eruption are very important topics in dentistry. However, they remain among the less-studied and -understood subjects. Root development accompanies rapid tooth eruption, but roots are required for the movement of teeth into the oral cavity. It has been shown that the dental follicle and bone remodeling are essential for tooth eruption. So far, only limited genes have been associated with root formation and tooth eruption. This may be due to the difficulties in studying late stages of tooth development and tooth movement and the lack of good model systems. Transgenic mice with eruption problems and short or no roots can be used as a powerful model for further deciphering of the cellular, molecular, and genetic mechanisms underlying root formation and tooth eruption. Better understanding of these processes can provide hints on delivering more efficient dental therapies in the future.

Oral and dental care in acute lymphoblastic leukaemia: a survey of united kingdom children's cancer study group centres

OBJECTIVES

To examine the provision of oral and dental care for children receiving treatment for acute lymphoblastic leukaemia (ALL) in United Kingdom Children's Cancer Study Group (UKCCSG) centres.

SAMPLE AND METHODS

A postal questionnaire was sent to a named consultant at each centre. All 22 centres responded.

RESULTS

The majority of centres carry out an oral assessment at the time of diagnosis, although various health care professionals are responsible for this. A dentist routinely attends out-patient clinics in only a minority of centres, although the majority have facilities for the provision of dental treatment 'on site'. In the main, children requiring dental treatment are referred to the Hospital Dental Service. Almost a quarter of centres do not have an oral care protocol.

CONCLUSIONS

The development of appropriate dental services at tertiary referral centres should be vigorously pursued.

Dento-maxillofacial sequelae in a child treated for a rhabdomyosarcoma in the head and neck. A case report

This case report describes severe dento-maxillofacial defects after chemoradiation therapy in a child aged 9 years 6 months with a parameningeal rhabdomyosarcoma. A clinical and radiologic (apical dental radiographs, orthopantograph, lateral skull roentgenogram) dental follow-up over 4 years showed such dental abnormalities as root blunting, mild to severe root shortening, premature closure of the root apices, and severe radiation caries. Craniofacial morphology evaluated by cephalometric analysis and dental models showed deficiency with mandibular and maxillary hypoplasia.

Tooth eruption: theories and facts

The mechanisms of tooth eruption (i.e., the answer to the question of how and why teeth erupt) has been a matter of long historical debate. This review focuses on human and other mammalian teeth with a time- and spacewise limited period of eruption and analyzes recent observations and experimental data on dogs, rats, primates, and humans in a framework of basic biological parameters to formulate a guiding theory of tooth eruption. Acknowledging basic parameters (i.e., that teeth move in three-dimensional space, erupt with varying speed, and arrive at a functional position that in inheritable) eliminates a number of previously held theories and favors those that accommodate basic parameters, such as alveolar bone remodeling in association with root elongation, with possible correction factors in the form of cementum apposition and periodontal ligament formation. We have critically analyzed, summarized, and integrated recent findings associated with preeruptive movements of developing teeth, the intraosseous stage of premolar eruption in dogs, molar eruption in rodents, and premolar and molar eruption in primates. The variable speeds of eruption are particularly important. We conclude with basic principles of tooth eruption--that is, the type of signals generated by the dental follicle proper, the conditions under which teeth are moved and the clinical understanding to be derived from this knowledge.

The basic and applied biology of tooth eruption

The dentition and the alveolar process of each jaw develop simultaneously so that, by the time the crown is completed and eruption begins, the crown is enclosed in a crypt within alveolar bone. Thus, the eruption of a tooth to its functional position involves discretely localized, bilaterally symmetrical bone resorption to produce an eruption pathway and bone formation to fill in the space previously occupied by the crown and growing roots. Studies of crypt surfaces during eruption confirm this polarization of alveolar bone metabolism around a tooth with respect to both bone cells and mineralized surface topography. Experimental studies of tooth eruption have shown that the dental follicle, the dense connective tissue investment of the tooth, is necessary for eruption and that neither bone resorption nor bone formation occur without the adjacent part of the dental follicle. Early in eruption the coronal part of the follicle accumulates mononuclear cells which have cytochemical and ultrastructural features of osteoclasts and the apical part of the follicle, a site of intense cell proliferation, binds epidermal growth factor (EGF). The dental follicle contains a variety of proteins and the concentration of several change during eruption. Prominent among them are a reduction in matrix metalloproteinases and an increase in protoglycans as eruption proceeds. The contribution of these changes to those in cell proliferation, migration and differentiation during tooth eruption present experimental opportunities for developmental biologists. The rate-limiting factor of the earliest (intraosseous) stage of tooth eruption is bone resorption and eruption can be accelerated or retarded by the local delivery of factors which increase or decrease the activity of osteoclasts.(ABSTRACT TRUNCATED AT 250 WORDS)

Current concepts of the biology of tooth eruption

Tooth eruption is defined as the movement of a tooth from its site of development within the jaws to its position of function within the oral cavity. We present a critical review of evidence for the mechanisms and regulation of the intraosseous and supraosseous phases of eruption, with an emphasis upon the canine premolar model studied by the authors. Analyses at different stages of premolar eruption indicate that selective fragmentation of dental follicle protein DF-95 correlates with the presence of elevated levels of follicular collagenase and stromelysin, and with the onset of premolar movement. A dramatic decrease in these metalloproteinases followed initiation of movement. A biochemical and cell biological model for regulation of tooth eruption is proposed based upon these new and existing data.

Mandibular growth and tooth eruption after localized x-radiation

The effect of localized x-radiation on the growth of mandibular bone and molar eruption was evaluated by morphometric methods. A dose of 20 Gy of x-radiation was given to the molar zone of growing rats. The animals were then killed in groups at 30 and 60 days postirradiation. Two groups of nonirradiated, age-matched rats were used as controls. Parameters related to molar eruption, mandibular length, and mandibular height were measured on lateral radiographs. The results obtained showed that the values of the biometric parameters were lower in experimental than in control animals. Odontoblastic atrophy, alveolodentary ankylosis, and meager or no root formation were the most conspicuous histologic findings. Osteodentin was found between canaliculary dentin and bone in cases of ankylosis. The morphometric data presented confirm the probability of alterations in mandibular growth and tooth eruption following x-radiation and suggest that this be considered in planning radiotherapy in children.

Impaired tooth root development after treatment of a cerebellar astrocytoma: a case report

A young man, previously treated by surgical resection of a grade III cerebellar astrocytoma in combination with irradiation and chemotherapy, was found to display severe generalized root agenesis. This patient also exhibited secondary hypothyroidism and decreased levels of growth hormone. These factors are discussed in relation to their possible role in impaired root development.

Rhabdomyosarcoma of the oral and paraoral region

Oral rhabdomyosarcoma (RMS) was studied by analysis of eight such cases which presented over a 25-year period. Rhabdomyosarcoma was the fourth most common oral sarcoma (7.5%) from this period after osteosarcoma (32%), fibrosarcoma (19%), and chondrosarcoma (9%). In patients younger than 20 years, RMS was the second most common sarcoma (six cases) after osteosarcoma (ten cases). Combined analysis with 113 further cases documented in the literature showed the majority of cases (71.2%) were embryonal. The alveolar subtype was considered a distant second in frequency (12.3%) even though the pleomorphic subtype was apparently more common (16.4%). However, the pleomorphic cases were diagnosed before histologic criteria were established to discern this entity from other pleomorphic sarcomas and this data is probably unreliable. Site predilections were found for the soft palate, maxillary sinus and alveolus, posterior mandibular region, cheek and lip and possibly tongue. The gingiva and floor of mouth were uncommon sites. There was a predilection for occurrence in the first two decades with a decline in the third decade. Documentation of recent cases treated with a multidisciplinary approach indicated that lesions in the oral soft tissues have a good prognosis; 17 of 21 such cases showed no evidence of disease after a mean follow-up period of 7.2 years (SD = 4.4). In contrast, four of five cases in the posterior mandible resulted in death after a mean period of 1.1 years (SD = 0.3).

Changes in the tartrate-resistant acid phosphatase cell population in dental follicles and bony crypts of rat molars during tooth eruption

It was the aim of this study to determine the cellular changes that occur in the enamel organ, dental follicle, and surrounding bony crypt of the rat molar prior to and during tooth eruption. By use of light microscope histochemistry to detect cells containing tartrate-resistant acid phosphatase (TRAP), it was seen that TRAP-positive mononuclear cells were present in the dental follicle prior to the onset of eruption (e.g., three days postnatal age) and then declined in number during eruption. Concurrently, TRAP-positive osteoclasts were initially present in large numbers on the surface of the bony crypts surrounding the molars (three days postnatal age) and then declined in number as eruption progressed. Electron microscopy confirmed that these were mononuclear cells and osteoclasts. The results suggest that the mononuclear cells are either precursors of the osteoclasts or perhaps release cytokines that affect osteoclast formation or activity. Staining for alkaline phosphatase (ALP) activity indicated that at an early postnatal age (secretory stage of amelogenesis), ALP was detected only in the stratum intermedium of the enamel organ, whereas at a later age (maturation phase of amelogenesis), it was present only in the ameloblasts. These results, combined with a survey of the literature, strongly suggest that ALP moves from the base of the enamel organ to the enamel itself over a period of time ranging from pre- to post-eruption. Rat molars are teeth of limited eruption, and the cellular events that occur in eruption appear comparable with what is seen in dog and human dentition, especially in terms of the cellular events seen in the dental follicle prior to and during eruption.(ABSTRACT TRUNCATED AT 250 WORDS)

Failure of root development of human permanent teeth following irradiation

Complete absence of root formation of the upper incisors, canine and first premolar was reported in a 27-year-old female who had received radiation therapy for a retinal glioma of the right eye at age of 3 years 1 month. Ground and decalcified sections showed no remarkable changes in enamel and dentin of the crowns, but the pulp floor was closed by irregular dentin deposit despite the absence of root formation. The outer surface of the irregular dentin was covered by acellular cementum, and the periodontal membrane was undeveloped. A slight degree of fibrosis was seen in the pulp, but the coronal part of the dentin was lined by odontoblasts. The theory that tooth eruption is caused by the growth of the root is not substantiated by the observation in this case.

Regional control by the dental follicle of alterations in alveolar bone metabolism during tooth eruption

Tooth eruption is a localized, bilaterally symmetrical series of events which involves resorption and formation of alveolar bone on opposite sides of the tooth and requires the presence of the dental follicle. We examined the effect on eruption of selective surgical removal of parts of the follicle. Removal of either the basal or coronal halves of the follicle prevented eruption. Bone resorption and formation of an eruption pathway did not occur after removal of the coronal part of the follicle and bone formation did not occur after removal of the basal part of the follicle. Exposure and incisions of the follicle had no effect on eruption. We interpret these data to mean that the polarized resorption and formation of alveolar bone that occur around a tooth during eruption are regulated by the adjacent parts of the dental follicle.

Oral presentations in non-Hodgkin's lymphoma: a review of thirty-one cases. Part III. Six cases in children

This is the third in a series of articles dealing with oral presentations in non-Hodgkin's lymphoma. In this section the authors discuss the clinical and microscopic features of six cases occurring in children, four of which qualified as Burkitt's lymphoma.

Experimental study in the dog of the non-active role of the tooth in the eruptive process

The role of the tooth in eruption was studied radiographically and histologically after experimental manipulations of the crowns of permanent mandibular premolars in dogs. Crowns were removed and dead crown shells or metal or silicone replicas were substituted into dental follicles just prior to scheduled eruption. These replacements erupted on schedule after formation of the usual eruption pathways and formation of trabecular bone from the base of the bony crypt. Removal of crowns, but without adding replacements, also exhibited these same hallmarks of eruption. We conclude that tooth eruption is a series of metabolic events in alveolar bone characterized by bone resorption and formation on opposite sides of the dental follicle and the tooth does not contribute to this process.

The cytology of the dental follicle and adjacent alveolar bone during tooth eruption in the dog

Previous studies from our laboratories have shown that premolar eruption in dogs depends upon the presence of the dental follicle and is independent of root or crown growth or attachment to the oral epithelium. The present study is an analysis of the cellular composition of the dental follicle and the cellular investment of the adjacent walls of the bony crypt before and during eruption of the third and fourth mandibular permanent premolars in young beagle dogs. Four premolar follicles and their adjacent bony crypts were examined at 2-week intervals over 12 weeks before and during eruption of these teeth. Tissues were removed, fixed, processed, and oriented so that each follicle and the adjacent crypt wall could be reproducibly examined in vertical and horizontal planes. Mononuclear cells with abundant cytoplasm, euchromatic nuclei, and prominent nucleoli were present in juxtavascular location in the coronal part of the dental follicle; and these cells increased in number immediately preceding and during tooth eruption in parallel with an increase in osteoclasts on the adjacent crypt wall. These data are interpreted to mean that the coronal part of the dental follicle may coordinate the alveolar bone resorption required for tooth eruption by attracting and directing to the crypt wall a population of mononuclear cells, which either become osteoclasts and/or direct osteoclastic activity during tooth eruption.

Chronology and histology of exfoliation and eruption of mandibular premolars in dogs

Exfoliation of third deciduous mandibular premolars and their replacement by the third permanent premolars were compared in young dogs of purebred beagle and mongrel stock. Radiographic and histologic studies showed that eruption of the permanent premolar begins during the 16th postnatal week and is completed in 7 weeks. Root elongation proceeds with eruption, but fibers of the periodontal ligaments are not anchored in alveolar bone and do not attain their final orientation with respect to the long axis of the tooth until final phase of the eruptive period. These data define a predictable system in which various stages in the mechanism of eruption of noncontinuously erupting teeth may be examined experimentally. Furthermore, the observation that these processes are identical in timing and sequence in beagle and mongrel dogs suggests that less expensive, more readily available mongrel dogs can be used for these studies.