Cancer Res Treat.  2018 Jul;50(3):926-935. 10.4143/crt.2017.296.

Clinical Risk Factors Influencing Dental Developmental Disturbances in Childhood Cancer Survivors

• Kang CM
• Hahn SM
• Kim HS
• Lyu CJ
• Lee JH
• Lee J
• Han JW

• KMID: 2417881
• DOI: http://doi.org/10.4143/crt.2017.296

Abstract

PURPOSE
Although 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 METHODS
Oral 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.
RESULTS
In 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.
CONCLUSION
CCS 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.

Keyword

Neoplasms; Survivors; Adverse effects; Odontogenesis; Tooth abnormalities

MeSH Terms

Diagnosis
Diagnosis, Oral
Hematopoietic Stem Cell Transplantation
Humans
Multivariate Analysis
Odontogenesis
Retrospective Studies
Risk Factors*
Survivors*
Tooth
Tooth Abnormalities

Figure

• 

  Fig. 1. A panoramic radiograph (A) and schematic presentation (B) of the method of calculation of the Modified Dental Defect Index (MDDI) score for a patient (7 years and 11 months, male) with Ewing’s sarcoma. The patient received 45 Gy of radiation to the ethmoid region at 3 years and 2 months of age and chemotherapy with doxorubicin (300 mg/m2) at 1 year and 7 months of age. Twelve permanent teeth are missing, and the development of all present teeth is severely affected. The total MDDI score is 130.

• 

  Fig. 2. (A) Proportions of patients with tooth agenesis, microdontia, abnormal root development, and combined anomalies in the three age groups of childhood cancer survivors (youngest, ≤ 3 years; middle, 3-5 years; oldest, ≥ 5 years). The prevalence of agenesis or microdontia is the highest in the youngest group, while that of abnormal root development exhibits a tendency to increase in the older groups. (B) Distribution of teeth affected by tooth agenesis and microdontia. The data show that microdontia is most common in the maxillary second premolars and second molars, while tooth agenesis is most common in the maxillary and mandibular second premolars. U1, upper (maxillary) central incisor.

• 

  Fig. 3. Relationship between Modified Dental Defect Index (MDDI) scores and treatment factors in the three age groups of childhood cancer survivors (youngest, ≤ 3 years; middle, 3-5 years; oldest, ≥ 5 years). (A) The MDDI score for the youngest group is significantly different compared to the middle and oldest groups (p < 0.001). (B) The MDDI score is significantly higher in the youngest group diagnosed with brain tumors (p=0.042). (C) The MDDI score is significantly higher in youngest group treated with hematopoietic stem cell transplantation (p=0.001). (D) The MDDI score is significantly higher in youngest group treated with head and neck radiation therapy at a dose of ≥ 40 Gy (p=0.002). (E) The MDDI score is significantly higher in the youngest group receiving ≥ 4 classes of chemotherapeutic agents (p=0.003). (F) The use of heavy metal agents significantly increases the MDDI score in the youngest and middle groups (p=0.004 and p=0.037, respectively).

Reference

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