Dentofacial development in long-term survivors of acute lymphoblastic leukemia: A comparison of three treatment modalities

Abstract

Ninety-seven children who were diagnosed with acute lymphoblastic leukemia before 10 years of age and treated with chemotherapy alone, chemotherapy plus 1800-cGy cranial irradiation (RT), or chemotherapy plus 2400-cGy RT were evaluated for effects of therapy on dentofacial development. All patients were seen at least 5 years postdiagnosis. Dental abnormalities were determined from panoramic radiographs, and craniofacial evaluations were made from lateral cephalometric radiographs. Ninety-one (94%) of all patients and 41 (100%) of patients younger than 5 years of age at diagnosis had abnormal dental development. The severity of these abnormalities was greater in children who received treatment before 5 years of age and in those who received RT. Observed dental abnormalities included tooth agenesis, arrested root development, microdontia, and enamel dysplasias. Craniofacial abnormalities occurred in 18 of 20 (90%) of those patients who received chemotherapy plus 2400-cGy RT before 5 years of age. Mean cephalometric values of this group showed significant deficient mandibular development. The results of this study suggest that the severity of dentofacial-developmental abnormalities secondary to antileukemia therapy are related to the age of the patient at the initiation of treatment and the use of cranial RT.

Association of cyclophosphamide use with dental developmental defects and salivary gland dysfunction in recipients of childhood antineoplastic therapy

“…These findings were consistent with previous studies. [5][6][7][8][9][10][11][12][13] Dental development is a complex and prolonged process. The development of permanent teeth is initiated between 5 months in utero and 9 months postnatally (excluding third molars), and the initial calcification process (excluding third molars) occurs between 3 months and 3 years of age and continues until coronal development is complete around 8 years of age.…”

“…1 Well-established long-term effects of antineoplastic treatment include dental disturbances such as microdontia, 2 atypical root formation, 3,4 and tooth aplasia. [5][6][7][8][9][10][11][12][13][14] Other effects include hyposalivation, [15][16][17] dental immaturity and disturbances in dental eruption, as well as trismus and osteoradionecrosis. 18 However, it is difficult to attribute these effects to any single agent or treatment modality, as multimodal therapy is employed in almost all childhood cancers.…”

Root malformation associated with a cervical mineralized diaphragm – a distinct form of tooth abnormality?

“…6,7 In these conditions, the root dysplasia is generalized or affects a continuous section of a dental arch. Premature arrest of radicular development results from local events such as traumas, infections, or radiation therapy, systemic influences like chemotherapy, [8][9][10] and sometimes without any apparent reason. 11 Therefore, this type of dysplasia usually affects individual teeth or a specific group of teeth, roots of which form at the time of the external insult.…”

Effect of Photobiomodulation on Vinblastine-Poisoned Murine HERS Cells

“…This indicates that HERS cells are sensitive to vinblastine at/near commonly used pharmacologic doses, and adds support to clinical findings that abnormal root morphology in childhood cancer survivors is the result of damage to HERS cells proliferating at the time of chemotherapy. [1][2][3][4][5][6][7] There was a beneficial effect of photobiomodulation on HERS cell recovery from vinblastine exposure. The greatest effects of the light treatment were noted at the LD 50 .…”

“…1 Numerous studies of the long-term effects of chemotherapy on dental development have found that the most common abnormality is atypical root morphology. [2][3][4][5][6][7] Hertwig's epithelial root sheath (HERS) cells are considered to be the cells responsible for root formation. The apical migration of these cells during root development determines the eventual morphology of the root.…”