The Broad Variability in Dental Age Observed among Childhood Survivors Is Cancer Specific

Abstract

Purpose: The study aimed to assess the differences in dental maturation between childhood cancer survivors and healthy children.

Materials and methods: Fifty-nine cancer patients including 16 (27.1%) girls and 43 (72.8%) boys, aged between 4 and 16 years, underwent dental and radiographic examinations. The mean duration of anticancer therapy was 16.8 months (range, 1 to 47 months), and 4.6 years (range, 8 to 123 months) had passed since the termination of disease. The control group consisted of 177 panoramic radiographs of age- and sex-matched healthy individuals. Dental age (DA) was estimated with Demirjian's scale and delta age, i.e., DA-chronological age (CA), was used to compare groups.

Results: The DA of cancer survivors was accelerated by almost 1 year compared to their CA (9.9±3.1 vs. 8.9±2.8, p=0.040). The greatest difference was observed among patients with brain tumor: delta (DA-CA) was 2.2±1.1 years. Among all cancer patients, only children with familial adenomatous polyposis (FAP)-associated hepatoblastoma (HP) demonstrated delayed DA, with regard to both other cancer survivors (p=0.011) and healthy patients (p=0.037). All four patients with HP suffered from FAP, and three of them had documented adenomatous polyposis coli (APC) genes mutation. The DA of cancer patients having teeth with short roots was significantly greater than that of the cancer survivors without this anomaly (12.8±3.2 vs. 9.0±2.4, p < 0.001).

Conclusion: DA in children may be altered by cancer disease.

Keywords: APC genes; Cancer survivors; Dental age estimation; Hepatoblastoma.

Fig. 1.

Diagram of Demirjian’s classification. Stage description (Demirjian et al. Hum Biol. 1973;45:211-27 [7]). (A) In both radicular and multiradicular teeth, a beginning of calcification is seen at the superior level of the crypt in the form of an inverted cone or cones. There is no fusion of these calcified points. (B) Fusion of the calcified points forms one or several cusps which unite to give a regularly outlined occlusal surface. (C) Enamel formation is complete at the occlusal surface. Its extension and convergence towards the cervical region is seen. The beginning of a dentinal deposit is seen. The outline of the pulp chamber has a curved shape at the occlusal border. (D) The crown formations completed down to the cemento-enamel junction. The superior border of the pulp chamber in the uniradicular teeth has a definite curved form, being concave towards the cervical region. The projection of the pulp horns if present, gives an outline shaped like an umbrella top. In molars the pulp chamber has a trapezoidal form. Beginning of root formation is seen in the form of a spicule. (E) Uniradicular teeth: The walls of the pulp chamber now form straight lines, whose continuity is broken by the presence of the pulp horn, which is larger than in the previous stage. The root length is less than the crown height. Molars: Initial formation of the radicular bifurcation is seen in the form of either a calcified point or a semi-lunar shape. The root length is still less than the crown height. (F) Uniradicular teeth: The walls of the pulp chamber now form a more or less isosceles triangle. The apex ends in a funnel shape. The root length is equal to or greater than the crown height. Molars: The calcified region of the bifurcation has developed further down from its semi-lunar stage to give the roots a more definite and distinct outline with funnel shaped endings. The roots length is equal to or greater than the crow height. (G) The walls of the root canal are now parallel and its apical end is still partially open (distal root in molars). (H) The apical end of the root canal is completely closed (distal root in molars). The periodontal membrane has a uniform width around the root and the apex.

Fig. 2.

Differences in dental age to chronological age between cancer survivors and control patients.

Fig. 3.

Values of delta dental age to chronological age in patients with different types of cancer (A) and hepatoblastoma compared to the healthy patients and other cancer patients (B). Gray zone represents interquartile range for healthy controls.

Fig. 4.

Differences in dental age to chronological age in cancer patients according to tooth abnormalities: short roots (A), microdontic teeth (B), and hypodontia (C).