Disturbed root development of permanent teeth after pediatric stem cell transplantation

Abstract

BACKGROUNDDeficient dental root development has been reported after conventional pediatric anticancer therapy, but less information is available on stem cell transplantation (SCT) recipients.METHODSRoot‐crown (R/C) ratios of fully developed permanent teeth were assessed from panoramic radiographs of 52 SCT recipients, who were treated when they were age < 10 years. Using standard deviation scores (SDSs), the authors compared the R/C ratios to the corresponding tooth and gender‐specific values in a healthy population. The percentage of affected R/C ratios per individual was examined in a subgroup of 39 (SG39) patients with advanced tooth development. The effects of total body irradiation (TBI) and SCT age on the R/C ratios were studied in TBI and high‐dose chemotherapy (HDC = non‐TBI) groups and in 3 age groups (≤ 3.0 years, 3.1–5.0 years, ≥ 5.1 years).RESULTSPer individual, 77% of the fully developed permanent teeth were affected in SG39. At the tooth level, in 77% of the 945 teeth studied (52 patients), the R/C ratios were outside ±2 SDSs. More teeth were affected in the TBI (85%) than in the non‐TBI (55%) group (P < 0.001). The teeth of the patients who were ages 3.1–5.0 years old at SCT presented with the most severe aberrations of the R/C ratio (mean SDS = −4.4) whereas the teeth of the youngest (age ≤ 3.0 years) and the oldest (age ≥ 5.1 years) patients were equally affected (mean SDSs = −3.1 and −3.0, respectively).CONCLUSIONSDisturbances of dental root growth always followed pediatric SCT. HDC alone intensely harmed root growth but TBI further increased the adverse effects that were most extensive in the patients 3.1–5.0 years at SCT. These sequelae should be taken into account during the lifelong dental follow‐up to minimize the clinical consequences of dental injuries. Cancer 2005. © 2005 American Cancer Society.

Oral features and dental health in Hurler Syndrome following hematopoietic stem cell transplantation

“…Dilaceration of the distal root of first and second permanent molars and delayed root formation was noted by Worth in his report on patients with Hurler Syndrome in 1966. Disturbed dental root development has also been observed in patients who have received HSCT as part of their management of malignant disease 21 . Such disturbances were more extensive in the patients who were between 3.1 and 5.0 years at time of transplant 21 .…”

Antineoplastic chemotherapy and congenital tooth abnormalities in children and adolescents

“…resorption, V-shape, U-shape, taurodontism (in the case of excessive vertical elongation of the tooth chamber with no tooth neck, and a lowered root bifurcation in multiradicular teeth) [23, 47–49]. Höltta’s defect index (DeI) was used [23]. …”

“…vincristine, colchicine, and vinblastine temporarily impair odontoblast activity [7, 43–45]. Chemotherapy probably also delays the development of the Hertwig sheath [23]. …”

Relationships between the root-crown ratio and the loss of occlusal contact and high mandibular plane angle in patients with open bite

“…The background of developmentally short-rooted permanent teeth may be genetic (known as short root anomaly) [8][9][10] or exogenous, such changes associated with chemotherapy or radiation therapy. 22 In sex-linked genes, several studies have suggested that the promoting effect of the Y chromosome on root growth is greater than that of the X chromosome 14 ; this may be the reason for longer roots in males than females. In the present study, patients with malocclusion and craniofacial syndromes were excluded, and the ratio of males to females in the control group was nearly the same as that in the openbite group.…”