Clinical Risk Factors Influencing Dental Developmental Disturbances in Childhood Cancer Survivors

Abstract

PurposeAlthough studies regarding dental developmental disturbances after childhood cancer treatment have increased, they have many limitations. Studies analyzing the significance of independent clinical risk factors with regard to the dental health status are also rare. We aimed to investigate the risk factors for dental developmental disturbances, particularly severe disturbances, in childhood cancer survivors (CCS).Materials and MethodsOral examinations and retrospective reviews of medical and panoramic radiographs were performed for 196 CCS (mean age, 15.6 years). Cancer type, age at diagnosis, treatment modality, type and accumulated dose of administered drugs, and dose and site of radiation were recorded. Dental developmental disturbances were diagnosed using panoramic radiographs and graded for severity according to the Modified Dental Defect Index (MDDI). Descriptive statistics and multivariate analyseswere performed to determine the association between dental abnormalities and clinical factors.ResultsIn total, 109 CCS (55.6%) exhibited at least one dental anomaly, and the median value of MDDI was 2.5. Microdontia (30.6%) was the most prevalent anomaly, followed by tooth agenesis (20.4%), V-shaped roots (14.8%), and taurodontism (10.2%). Multivariate analysis revealed that a young age at diagnosis (≤ 3 years), a history of hematopoietic stem cell transplantation, the use of multiple classes of chemotherapeutic agents (≥ 4 classes), and the use of heavy metal agents were significant risk factors for severe dental disturbances.ConclusionCCS with any of the above risk factors for severe developmental disturbances should be comprehensively followed up to minimize adverse consequences to their dental development and preserve their future dental health.

Late effects of chemo and radiation treatment on dental structures of childhood cancer survivors. A systematic review and meta‐analysis

“…Most of the previous studies indicated that children subjected to H&N and TBI radiotherapy experienced more dental defects compared to children subjected to chemotherapy alone. 14,18,20,27 In a study by Näsman et al, 14 it was found that children treated with radiotherapy developed more dental defects as compared to children treated with multiagent chemotherapy. In another study, severe root defects presented in 9 out of 10 patients that received fractionated TBI, as compared to patients receiving chemotherapy alone who did not develop any late defects.…”

A critical look at prevalence assessment of dental abnormalities after chemotherapy. Clinical research

“…DeI or Modified Dental Defect Index (MDDI) was often used in previous studies, and it gave some information about the degree of damage to dental development [4,10,11,14]. However, the latency period was not always appropriate to show all of the post-treatment disturbances.…”

“…In the literature there is research undertaken one year after therapy completion [14]. Gawade et al [7,11] suggest a mini-mum two-year follow-up after finishing the anticancer treatment. Cubukcu et al [4] also used DeI to determine the total injury to permanent teeth, but they controlled the subjects in remission at least for five years.…”

“…Cubukcu et al [4] Microdontia is classified as the presence of halfsized or smaller tooth crown. Microdontia, in its precise meaning, is most often a subject of assessment of its prevalence [9][10][11]21]. However, sometimes the infor- mation on the degree of crown damage is not indicated in the study or is described as tooth size smaller than average [1,17,18,22].…”

“…Therefore, the authors of the current study conducted a comparable assessment of tooth size within the same class of teeth following determination of the anomaly. When it comes to lateral incisors and third molars, some researchers do not take into account the disturbances concerning these teeth because of their higher prevalence in a healthy population [11,12]. In fact, hypodontia of at least one of the third molars was noted in 35% and microdontia of lateral incisors in 1.7% of the general population [9,12].…”