Microdontia associated with the use of radıotherapy and chemotherapy of a non-hodgkın lymphoma: report of two cases

Atatürk Üniv. Diş Hek. Fak. Derg. J Dent Fac Atatürk Uni Cilt:22, Sayı:1, Yıl: 2012, Sayfa: 77-82 BAYGIN, TÜZÜNER, TANRIVER Olgu Sunumu/ Case Report MICRODONTIA ASSOCIATED WITH THE USE OF RADIOTHERAPY AND CHEMOTHERAPY OF A NON-HODGKIN LYMPHOMA: REPORT OF TWO CASES NON-HODGKİN LENFOMADA RADYOTERAPİ VE KEMOTERAPİ SONUCU GÖRÜLEN MİKRODONTİ: 2 OLGU SUNUMU Özgül BAYGIN (PhD)* Tamer TÜZÜNER (PhD)** Mehmet TANRIVER (Research Assistant)*** Makale Kodu/Article code: 422 Makale Gönderilme tarihi: 27.10.2010 Kabul Tarihi: 05.05.2011 ABSTRACT ÖZET One of the childhood malignancies can be defined as non-Hodgkin lymphomas. These are known as the third most common malignancies in children and adolescents. Burkitt's lymphoma is a poorly differentiated rare and aggressive type of nonHodgkin's lymphoma. Clinically, this disease occurs mostly in children. The incidence peaks between ages 3-8 years. It is well known that using chemotherapy and radiotherapy procedures could improve the survival rate of these malignant diseases. However, treatments may cause deleterious effects. Dentofacial abnormalities are known as the most common longterm side effects after the usage of chemotherapy and/or radiotherapy procedures in growing patients. These disturbances can be seen in different ways such as arrested root development, disturbances in enamel formation, discolorations, microdontia, anodontia, altered tooth eruption and mandibulary/maxillary hypoplasia. Mainly, several factors such as age, treatment time, radiation dose/ duration time of chemotherapy may effect the outcomes of these side effects. In such studies, dental disturbances have been shown in children who were treated before the ages of 5-6 years. This article reports the long-term alterations on dental development in two patients who had been treated with antineoplastic therapy at the age of 3-6 years. Chemotherapy and radiotherapy procedures were used together. Microdontia and arrested root development were detected in premolar teeth for both patients at follow up periods. These case reports indicated that children who had been exposed to the chemotherapy and/or radiotherapy procedures might have an increased risk of having developmental dental disturbances and should be carefully followed up during the developing dentition. Key words: Chemotherapy, radiotherapy, pediatric dentistry Çocukluk döneminde görülen malignensilerden birisi non-Hodgkin lemfoma olarak adlandırılabilir. Bunlar çocukluk ve ergenlik döneminde 3. en sık görülen malignensilerdir. Burkitt lemfoma zor teşhis edilen, nadir ve agresif bir non-Hodgkin lemfomadır. Klinik olarak, bu hastalık en çok çocuklarda görülür. İnsidansı 3-8 yaş arasında zirve yapar. Kemoterapi ve radyoterapi işlemlerinin bu malignant hastalıklarda sağ kalım oranını yükselttiği iyi bilinmektedir. Ancak, tedaviler zararlı etkiler de yapabilmektedir. Dentofasiyal anomaliler büyüme çağındaki hastalarda kemoterapi ve/veya radyoterapi kullanımı sonrası en çok görülen yan etki olarak bilinmektedir. Bu bozukluklar kök gelişiminin durması, mine oluşumunda bozukluk, renklenmeler, mikrodonti, anodonti, diş sürmesinde bozukluk ve mandibuler/maksiler hipoplazi gibi değişik şekillerde görülebilir. Aslında hastanın yaşı, tedavi zamanı, kemoterapinin ve radyasyonun dozu/süresi gibi birkaç faktör bu yan etkilerin sonuçlarını etkileyebilir. Bu tür çalışmalarda, 5-6 yaşından önce tedavi edilen çocuklarda dental bozukluklar gösterilmiştir. Bu makale 3-6 yaş arasında antineoplastik terapiyle (kemoterapi-radyoterapi) tedavi edilen 2 hastada dental gelişimdeki uzun dönem değişiklikler bildirilmektedir. Takip periyotlarında her iki hastada premolar dişlerinde mikrodonti ve kök gelişiminde durma tespit edilmiştir. Bu vaka raporları kemoterapi ve/veya radyoterapi işlemlerine maruz kalan hastaların gelişimsel diş bozuklukları yönünden artmış bir riske sahip olduklarını ve gelişim sırasında dentisyonun dikkatlice takip edilmesine işaret etmektedir. Anahtar kelimeler: Kemoterapi, radyoterapi, pediatrik diş hekimliği *Karadeniz Technical University, Faculty of Dentistry, Department of Pediatric Dentistry **Karadeniz Technical University, Faculty of Dentistry, Department of Pediatric Dentistry ***Karadeniz Technical University, Faculty of Dentistry, Department of Pediatric Dentistry *15th BaSS Congress / "I. Vellidis Congress Centre" Thessaloniki .(22-25 April 2010) 77 Atatürk Üniv. Diş Hek. Fak. Derg. J Dent Fac Atatürk Uni Cilt:22, Sayı:1, Yıl: 2012, Sayfa: 77-82 BAYGIN, TÜZÜNER, TANRIVER INTRODUCTION in children who were treated before the ages of 5–6 years.15 Although some investigations concerning this problem are reported in the literature there still exists no reliable data belonging to the specific long-term consequences of radiotherapy.10 This article reports the long-term effects of chemotherapy and radiotherapy for treatment of non-Hodgkin lymphoma and Burkitt’s lymphoma in two patients at the age of 3 and 6 years. Non-Hodgkin lymphomas are the third most common malignancies in children and adolescents, accounting for 10–13% of newly diagnosed cancers in these age groups in most developed countries.1 Burkitt’s lymphoma is a highly aggressive non-Hodgkin lymphoma that has the highest cell proliferation rate among human neoplasms.2 Clinically, this disease occurs mostly in children. The incidence peaks between ages 3 and 8 years, and males are affected about twice as frequently as females.3,4 The prognosis for childhood malignancies has improved, accomplished to a great extent by the combined use of radiotherapy and chemotherapy but chemotherapy and radiotherapy also have deleterious effects.5 This essay illustrates the effects of chemotherapy and radiotherapy on dentition in children and adolescents.6 These modalities alone or combination carry, however, the potential of causing organ-system morbidity.7 One of the most basic problems is the lack of specificity of radiation therapy in respect to diffentiating between neoplastic cells and metabolically active normal cells. Since advances in the therapy of malignant diseases resulted in an improved life expectancy, attention is now increasingly focused on the long-term side effects and treatmentrelated complications. In growing individuals, the dental sequelae to chemotherapy and radiation are irreversible. Although the immediate effect of chemoradiotherapy to orodental structures is wellknown, limited information exists on the late effects of the treatment to oral health and developing structures.8 Morphogenesis and calcification of teeth form a sequence of events that begins in utero and continues for 14–15 years. Abnormal events that occur during dental development have permanent sequelae that cannot be corrected later. Dental late effects of chemotherapy and/or radiotherapy in childhood may involve several kinds of developmental dental disturbances, including tooth agenesis, microdontia, enamel defects, discolorations, and disturbed root developmen (...truncated)