Dental anomalies in children submitted to antineoplastic therapy

REVIEW Dental anomalies in children submitted to antineoplastic therapy Camila Merida Carrillo,I Fernanda Nahás Pires Corrêa,II Nilza Nelly Fontana Lopes,III Marcelo Fava,I,IV Vicente Odone FilhoV I Hospital das Clı́nicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança ITACI, Hemato-oncology Service, Dentistry Department, São Paulo/SP, Brazil. II São Leopoldo Mandic Campinas, School of Dentistry, Campinas/SP, Brazil. III Universidade Federal de São Paulo (UNIFESP), School of Medicine, Pediatric Oncology Institute, GRAACC-IOP, Department of Dentistry, São Paulo/SP, Brazil. IV Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Instituto de Ciência e Tecnologia (http://www.fosjc.unesp.br/), São José dos Campos/SP, Brazil. V Faculdade de Medicina da Universidade de São Paulo, Department of Pediatric, São Paulo/SP, Brazil. Cancer is the third most frequent cause of death in children in Brazil. Early diagnosis and medical advances have significantly improved treatment outcomes, which has resulted in higher survival rates and the management of late side effects has become increasingly important in caring for these patients. Dental abnormalities are commonly observed as late effects of antineoplastic therapy in the oral cavity. The incidence and severity of the dental abnormalities depend on the child’s age at diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area. The treatment duration and aggressivity should also be considered. Disturbances in dental development are characterized by changes in shape, number and root development. Enamel anomalies, such as discoloration, opacities and hypoplasia are also observed in these patients. When severe, these abnormalities can cause functional and esthetic sequelae that have an impact on the children’s and adolescents’ quality of life. General dentists and pediatric dentists should understand these dental abnormalities and how to identify them aiming for early diagnosis and appropriate treatment. KEYWORDS: Tooth Abnormalities; Drug/Radiotherapy; Cancer; Child. Carrillo CM, Corrêa FN, Lopes NN, Fava M, Filho VO. Dental anomalies in children submitted to antineoplastic therapy. Clinics. 2014;69(6):433437. Received for publication on November 6, 2013; Accepted for publication on November 26, 2013 E-mail: Tel.: 55 11 2661-8880 development disturbances are characterized by changes in shape, size, number and root development. General dentists and pediatric dentists provide oral care to childhood cancer survivors. Therefore, it is imperative that they familiarize themselves with the adverse effects of cancer therapy. & INTRODUCTION Cancer is the third most frequent cause of death in children in Brazil, after accidents and violence (1). The survival rates of childhood cancer have significantly increased due to early diagnosis and advances in medicine, so attention has become focused on the late effects of antineoplastic therapy. Dental anomalies are among the most common long-term side effects of childhood cancer therapy in the oral cavity. They may lead to anatomic, functional and aesthetic sequelae, and severe abnormalities can cause malocclusion, affect facial development and impact the quality of life (2). The incidence and severity of dental abnormalities depend on the age at the diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area (3,4). The duration and severity of antineoplastic treatment should also be considered. Dental Epidemiology of childhood cancer More than 9,000 new childhood cancers are diagnosed annually in Brazil. Cancer is the third leading cause of death in the 1- to 19-year-old age group, behind accidents and violence. Childhood cancer requires special care for not only the psychological and social effects but also because of the high costs involved in diagnosis, treatment and long-term followup (5). The types of cancers that affect children younger than 15 years old are distinct from those that affect adults. The most prevalent childhood cancers are leukemias, lymphomas, central nervous system tumors, rhabdomyosarcoma, Wilms’ tumor, retinoblastoma and bone tumors; while in adults, lung, stomach, intestine, prostate and breast cancer predominate (6). The literature reports that during childhood, acute lymphocytic leukemia (ALL) is the most common malignancy, representing 24% of all childhood malignant neoplasias (7-9) and 75% of all childhood leukemias (10). The 0- to 4-year-old age group is cited as Copyright ß 2014 CLINICS – This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. No potential conflict of interest was reported. DOI: 10.6061/clinics/2014(06)11 433 Dental anomalies in pediatric cancer survivors Carrillo CM et al. CLINICS 2014;69(6):433-437 nonmalignant late effects, in which many organs can be affected, including the oral cavity (13,14)(Table 1). the age group most frequently affected by cancers; however, lymphomas, carcinomas and bone tumors are the most prevalent cancers in the 10-14-year-old age group (11,12). In Brazil, leukemia predominates in the 1- to 4-year-old age group (31.6%); lymphoma is dominant in the 15- to 18-yearold age group (35.6%), and central nervous system tumors have a similar prevalence (26%) in all patients younger than 14 years old (1 to 4, 5 to 9, and 10 to 14 years old)(1). With regard to gender, related studies agree that general tumors, leukemias, lymphomas and central nervous system tumors are more prevalent in males than in females (5). Late effects of treatment in the oral cavity Complications resulting from the cancer itself and from its treatment frequently affect the mouth. Chemotherapy and head and neck radiotherapy mainly affect developing tissues, such as teeth and oral soft tissues (15). Generally, many therapeutic modalities are used to treat childhood cancer. Chemotherapy and radiotherapy are often combined, making it difficult to later distinguish which treatment modality causes which effects (16). Oral late effects of cancer therapy are clinically significant because of the sequelae they can cause, which may interfere with the quality of life. The most commonly observed late effects of head and neck radiotherapy therapy include xerostomia, trismus, bone alterations that can cause osteoradionecrosis and craniofacial and dental anomalies (17-19). Dental anomalies are also caused by chemotherapy; the main late effects of this therapy are in the mouth (3,16,20). Late effects of childhood cancer therapy With the increasing number of childhood cancer survivors comes a high incidence of adverse effects because of more aggressive treatments protocols. Therefore, increas (...truncated)