The prevalence of dental developmental anomalies among childhood cancer survivors according to types of anticancer treatment

Abstract

Survival following childhood cancer has increased considerably. In an observational cross-sectional study, we assessed the prevalence of dental developmental anomalies (DDA) among childhood cancer survivors according to types of anticancer treatment. Permanent teeth were examined clinically and radiographically in 121 adolescents with a history of childhood malignancies, to identify DDA, namely hypomineralization or hypoplasia, microdontia, root changes and hypodontia. DDA were observed in 56/121 individuals (46%), in 309/3388 teeth (9%). Hypomineralization or hypoplasia of enamel appeared in 21 (17%) patients. Altered root development appeared in 26 patients and hypodontia affected 13 (10%). Dental anomalies were observed in 36 (43%) individuals who received chemotherapy and not radiation, in 20 (52%) who received radiotherapy, and in 15 (60%) of those who received head and neck radiotherapy. Among patients who received only chemotherapy, young age (6 years or younger) was associated with a higher number of malformed teeth. In conclusion, antineoplastic treatment that combines chemotherapy and radiotherapy appears to increase the risk of DDA. Radiation to the head and neck area was shown to particularly increase the risk of DDA. No specific chemotherapy agent was found to be associated more than the others with DDA.

Figure 1

Long term dental effects. (A) Hypoplasia in the front upper and lower teeth of a girl aged 9 years, treated for ALL at age 3.5 years. (B) Microdontia showing the second upper right premolar in a girl age 12 years, treated for neuroblastoma at age 4 years. (C) A panoramic radiograph of a 12-year-old boy diagnosed with Burkitt's lymphoma at age 4 years, revealing: C₁. Altered root development at the first lower right molar, C₂. Hypodontia of the second lower left molar. (D) Radiation caries in a 21-year-old boy treated for neuroectodermal tumor at age 14 years.