Advertisement

Supportive Care in Cancer

, Volume 27, Issue 5, pp 1891–1899 | Cite as

Oral and dental alterations and growth disruption following chemotherapy in long-term survivors of childhood malignancies

  • Deniz ÇetinerEmail author
  • Sedat Çetiner
  • Ahu Uraz
  • Gökhan H. Alpaslan
  • Cansu Alpaslan
  • T. Ufuk Toygar Memikoğlu
  • Ceyda Karadeniz
Original Article
  • 218 Downloads

Abstract

Purpose

More attention has been focused on the long-term side effects of treatment protocols since impressive advances in childhood cancer treatment have resulted in a growing population of patients. The purpose of this study was to investigate the disturbances of dento-facial development in children who were long-term survivors of childhood malignancies.

Methods

Fifty-three children (mean age, 10 years + 4 months) in long-term remission underwent oral/dental and radiographic examinations after completion of therapy. Crown and root malformations, gingival/periodontal status, enamel defects, discolorations, decayed and unerupted teeth, premature apexifications, agenesis, maximal interincisal opening and lateral movement of jaws, and soft tissue abnormalities were noted. Caries were evaluated by the decayed-missing-filled teeth (DMFT) index. Forty healthy children (mean age, 12 years + 4 months) belonging to the same age group and socioeconomic community were served as controls. All participants in the study were evaluated in terms of craniofacial development.

Results

The data of the study showed that higher prevalence of root malformation, unerupted teeth, and enamel hypoplasia were detected as a consequence of childhood cancer and/or antineoplastic therapy. Although no differences of craniofacial growth and development were observed between groups (P > 0.05), plaque and gingival index scores were statistically higher in the study group (P < 0.05).

Conclusion

A range of variations in dental structures is recognized as a side effect of childhood cancer therapy in long-term survivors of pediatric malignancies that may affect their quality of life.

Keywords

Chemotherapy Childhood Cancer Maxillofacial development 

Notes

Acknowledgements

The authors of the study would like to acknowledge Dr. Serpil Cula and Dr. Reha Alpar for statistical consultancy.

Compliance with ethical standards

The study protocol was approved by the Medical and Health Research Ethics Committee of Gazi University. Written informed consent was obtained from all participants and/or their guardians.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Bhaskar SN (1991) Orban’s oral histology and embryology, 11th edn. CV Mosby Company, St. Louis, pp 24–45Google Scholar
  2. 2.
    Duggal MS (2003) Root surface areas in long-term survivors of childhood cancer. Oral Oncol 39:178–183.  https://doi.org/10.1016/S1368-8375(02)00089-1 CrossRefGoogle Scholar
  3. 3.
    Goho C (1993) Chemoradiation therapy: effect on dental development. Pediatr Dent 15:6–12Google Scholar
  4. 4.
    Dens F, Boute P, Frans V, Declerck D (1995) Quantitative determination of immunologic components of salivary gland secretion in long-term, event-free pediatric oncology patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 79:701–714.  https://doi.org/10.1016/s1079-2104(05)80303-8 CrossRefGoogle Scholar
  5. 5.
    Dahlöff G (1998) Craniofacial growth in children treated for malignant disease. Acta Odontol Scand 56:378–382.  https://doi.org/10.1080/000163598428365 CrossRefGoogle Scholar
  6. 6.
    Gawade PL, Hudson MM, Kaste SC, Neglia JP, Constine LS, Robison LL, Ness KK (2014) A systematic review of dental late effects in survivors of childhood cancer. Pediatr Blood Cancer 61:407–416.  https://doi.org/10.1002/pbc.24842 CrossRefGoogle Scholar
  7. 7.
    Hölttä P, Hovi L, Saarinen-Pihkala UM, Peltola J, Alaluusua S (2005) Disturbed root development of permanent teeth after pediatric stem cell transplantation. Cancer 103:1484–1493.  https://doi.org/10.1002/cncr.20967 CrossRefGoogle Scholar
  8. 8.
    Satoh H, Uesugi Y, Kawabata T, Mori K, Fujii F, Kashimoto Y, Kajimura T, Furuhama K (2001) Morphological classification of dental lesions induced by various antitumor drugs in mice. Toxicol Pathol 29:292–299.  https://doi.org/10.1080/019262301316905246 CrossRefGoogle Scholar
  9. 9.
    Sonis AL, Tarbell N, Valachovic RW, Gelber R, Schwenn M, Sallan S (1990) Dentofacial development in long-term survivors of acute lymphoblastic leukemia: a comparison of three treatment modalities. Cancer 66(12):2645–2652.  https://doi.org/10.1002/CNCR2820661230 CrossRefGoogle Scholar
  10. 10.
    Kaste SC, Goodman P, Leisenring W, Stovall M, Hayashi RJ, Yeazel M, Beiraghi S, Hudson MM, Sklar CA, Robinson LL, Baker KS (2009) Impact of radiation and chemotherapy on risk of dental abnormalities: a report from the Childhood Cancer Survivor Study. Cancer 115:5817–5827.  https://doi.org/10.1002/cncr.24670 CrossRefGoogle Scholar
  11. 11.
    Nasman M, Forsberg CM, Dahllöf G (1997) Long-term dental development in children after treatment for malignant disease. Eur J Orthod 19:151–159.  https://doi.org/10.1093/ejo/19.2.151 CrossRefGoogle Scholar
  12. 12.
    Carl W, Sako K (1986) Cancer and the oral cavity. Quintessence Publishing Company, Chicago, pp 99–136Google Scholar
  13. 13.
    Specht L (2002) Oral complications in the head and neck radiation patient. Introduction and scope of the problem. Support Care Cancer 10(1):36–39.  https://doi.org/10.1007/s005200100283 CrossRefGoogle Scholar
  14. 14.
    Loe H, Silness J (1963) Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 21:533–551.  https://doi.org/10.3109/00016356309011240 CrossRefGoogle Scholar
  15. 15.
    Silness J, Loe H (1964) Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135.  https://doi.org/10.3109/00016356408993968 CrossRefGoogle Scholar
  16. 16.
    Curzon MEJ, Roberts JF, Kennedy DB (1996) Kennedy’s pediatric operative dentistry, 4th edn. Butterworth-Heinemann, USA, pp 3–13Google Scholar
  17. 17.
    Cheng KK, Molassiotis A, Chang AM (2002) An oral care protocol intervention to prevent chemotherapy-induced oral mucositis in pediatric cancer patients: a pilot study. Eur J Oncol Nurs 6(2):66–73.  https://doi.org/10.1054/ejon.2001.0161 CrossRefGoogle Scholar
  18. 18.
    Cheng KK, Chang AM, Yuen MP (2004) Prevention of oral mucositis in paediatric patients treated with chemotherapy: a randomized crossover trial comparing two protocols of oral care. Eur J Cancer 40:1208–1216.  https://doi.org/10.1016/j.ejca.2003.10.023 CrossRefGoogle Scholar
  19. 19.
    Fadda G, Campus G, Luglie P (2006) Risk factors for oral mucositis in pediatric oncology patients receiving alkylant chemotherapy. BMC Oral Health 6(13):1–8.  https://doi.org/10.1186/1472-6831-6-13 Google Scholar
  20. 20.
    Gippsland Oncology Nurses Group (2007) Cancer related mucositis management: GONG cancer care guidelines, pp 1–4. Retrieved from http://www.gha.net.au//Uploadlibrary/393586894mucositis_management_guidelines0606.pdf. Accessed June 2007
  21. 21.
    Figliolia SL, Oliveira DT, Pereira MC, Lauris JR, Mauricio AR, Oliveira DT, Mello de Andrea ML (2008) Oral mucositis in acute lymphoblastic leukemia: analysis of 169 pediatric patients. Oral Dis 14:761–766.  https://doi.org/10.1111/j.1601-0825.2008.01468 CrossRefGoogle Scholar
  22. 22.
    Hutton A, Bradwell M, English M, Chapple I (2010) The oral health needs of children after treatment for a solid tumor or lymphoma. Int J Pediatr Dent 20(1):15–23.  https://doi.org/10.1111/j.1365-263X.2009.00999 CrossRefGoogle Scholar
  23. 23.
    Pajari U, Larmas M, Lanning M (1988) Caries incidence and prevalence in children receiving antineoplastic therapy. Caries Res 22:318–320.  https://doi.org/10.1159/000261129 CrossRefGoogle Scholar
  24. 24.
    Jensen SB, Mouridsen HT, Reibel J, Brunner N, Nauntofte B (2008) Adjuvant chemotherapy in breast cancer patients induces temporary salivary gland hypofunction. Oral Oncol 44:162–173.  https://doi.org/10.1016/j.oraloncology.2007.01.015 CrossRefGoogle Scholar
  25. 25.
    Jensen SB, Pedersen AM, Reibel J, Nauntofte B (2003) Xerostomia and hypofunction of the salivary glands in cancer therapy. Support Care Cancer 11:07–225.  https://doi.org/10.1007/s00520-002-0407-7 Google Scholar
  26. 26.
    Dahllöf G, Bagesund M, Remberger M, Ringden O (1997) Risk factors for salivary dysfunction in children 1 year after bone marrow transplantation. Oral Oncol 33:327–331.  https://doi.org/10.1016/S0964-1955(97)00012-2 CrossRefGoogle Scholar
  27. 27.
    Pajari U, Poikonen K, Larmas M, Lanning M (1989) Salivary immunoglobulins, lysozyme, pH, and microbial counts in children receiving anti-neoplastic therapy. Scand J Dent Res 97:171–177.  https://doi.org/10.1111/j.1600-0722.1989.tb01446 Google Scholar
  28. 28.
    Van der Pas-van Voskuilen IGM, Veerkamp JSJ, Raber-Durlacher JE, Bresters D, Van Wijk AJ, Barasch A, McNeal S, Gortzak RA (2009) Long-term adverse effects of hematopoietic stem cell transplantation on dental development in children. Support Care Cancer 17:1169–1175.  https://doi.org/10.1007/s00520-008-0567-1 CrossRefGoogle Scholar
  29. 29.
    Pedersen LB, Clausen N, Schrøder H, Schmidt M, Poulsen S (2012) Microdontia and hypodontia of premolars and permanent molars in childhood cancer survivors after chemotherapy. Int J Pediatr Dent 22:239–343.  https://doi.org/10.1111/j.1365-263X.2011.01199 CrossRefGoogle Scholar
  30. 30.
    Dahllöf G, Barr M, Bolme P (1988) Disturbances in dental development after total body irradiation in bone marrow transplant recipients. Oral Surg Oral Med Oral Pathol 65:41–44.  https://doi.org/10.1016/0030-4220(88)90189-2 CrossRefGoogle Scholar
  31. 31.
    Nawrocki L, Libersa P, Lambilliotte A, Pichon F, True D, Lafforgue P, Libersa JC (2001) Dental anomalies following anticancer chemotherapy. Arch Pediatr 8:754–756CrossRefGoogle Scholar
  32. 32.
    Sevinir B, Cubukcu CE, Ercan I (2012) Disturbed dental development of permanent teeth in children with solid tumors and lymphomas. Pediatr Blood Cancer 58:80–84.  https://doi.org/10.1002/pbc.22902 CrossRefGoogle Scholar
  33. 33.
    Demirjian A, Goldstein H, Tanner JM (1973) A new system of dental age assessment. Hum Biol 45(2):211–227Google Scholar
  34. 34.
    Vasconcelos NPS, Caran EMM, Lee ML, Lopes NNF, Weiler RME (2009) Dental maturity assessment in children with acute lymphoblastic leukemia after cancer therapy. Forensic Sci Int 184:10–14.  https://doi.org/10.1016/j.forsciint.2008.11.009 CrossRefGoogle Scholar
  35. 35.
    Sheller B, Williams B (1996) Orthodontic management of patients with hematological malignancies. Am J Orthod Dentofac Orthop 109:575–580.  https://doi.org/10.1016/S0889-5406(96)70068-9 CrossRefGoogle Scholar
  36. 36.
    Levander E, Malmgren O (1988) Evaluation of the risk of root resorption during orthodontic treatment: a study of upper incisors. Eur J Orthod 10:30–38.  https://doi.org/10.1093/ejo/10.1.30 CrossRefGoogle Scholar
  37. 37.
    Dahllöf G, Jönsson A, Ulmner M, Huggare J (2001) Orthodontic treatment in long-term survivors after pediatric bone marrow transplantation. Am J Orthod Dentofac Orthop 120:459–465.  https://doi.org/10.1067/mod.2001.118102 CrossRefGoogle Scholar
  38. 38.
    Rosenberg SW, Kolodney H, Wong GY, Murphy ML (1987) Altered dental root development in long-term survivors of pediatric lymphoblastic leukemia; a review of 17 cases. Cancer 59:1640–1648.  https://doi.org/10.1002/1097-0142(19870501)59:9<1640::AID-CNCR2820590920 CrossRefGoogle Scholar
  39. 39.
    Nasman M, Bjork O, Soderhall S, Ringden O, Dahllof G (1994) Disturbances in the oral cavity in pediatric long-term survivors after different forms of antineoplastic therapy. Pediatr Dent 16:217–223Google Scholar
  40. 40.
    Mataki S (1981) Comparison of the effect of colchincine and vinblastine on the inhibition of dentinogenesis in rat incisors. Arch Oral Biol 26:955–961.  https://doi.org/10.1016/0003-9969(81)90103-5 CrossRefGoogle Scholar
  41. 41.
    Hsieh SG, Hibbert S, Shaw P, Ahern V, Arora M (2011) Association of cyclophosphamide use with dental developmental defects and salivary gland dysfunction in recipients of childhood antineoplastic therapy. Cancer 117:2219–2227.  https://doi.org/10.1002/cncr.25704 CrossRefGoogle Scholar
  42. 42.
    Pajari U, Lanning M, Larmas M (1988) Prevalence and location of enamel opacities in children after anti-neoplastic therapy. Community Dent Oral Epidemiol 16:222–226.  https://doi.org/10.1111/j.1600-0528.1988.tb01759 CrossRefGoogle Scholar
  43. 43.
    Avsar A, Elli M, Darka Ö, Pinarli G (2007) Long-term effects of chemotherapy on caries formation, dental development, and salivary factors in childhood cancer survivors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:781–789.  https://doi.org/10.1016/j.tripleo.2007.02.029 CrossRefGoogle Scholar
  44. 44.
    Alberth M, Kovalecz G, Nemes J, Math J, Kiss C, Marton IJ (2004) Oral health of long-term childhood cancer survivors. Pediatr Blood Cancer 43:88–90.  https://doi.org/10.1002/pbc.20023 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of Dentistry, Department of PeriodontologyGazi UniversityEmek/AnkaraTurkey
  2. 2.Faculty of Dentistry, Department of Oral & Maxillofacial SurgeryGazi UniversityAnkaraTurkey
  3. 3.Faculty of Dentistry, Department of OrthodonticsAnkara UniversityAnkaraTurkey
  4. 4.Faculty of Medicine, Department of Pediatric OncologyGazi UniversityAnkaraTurkey

Personalised recommendations