Annals of Diagnostic Paediatric Pathology

101
Table 1
Diagnosis, mean total dose and field of radiation in patients subjected to combined chemo-radiotherapy. Radiation fields
included teeth and teeth buds
Diagnosis
Number of
children (N)
Mean dose of
radiation (cGy)
Irradiated field
Medulloblastoma 18 3500
4500
Neural axis (brain and spinal cord)
Posterior fossa
Brainstem tumors 7 5400 Tumor site
Ependymoma 5 5400 Tumor site
Astrocytoma III 5 5400 Tumor site
Glioblastoma multiforme 2 5400 Tumor site
Carcinoma plexus chorioidei 3 5400 Tumor site
Nasopharyngeal
9 5400 Tumor site
rhabdomyosarcoma
Non-Hodgkin lymphoma 1 2400 Neural axis
Neuroblastoma stage IV 1 4500 Brain metastases
Retinoblastoma 1 4500 Lymph node metastases in head and
Table 2
Distribution of dentition types in the analyzed population of
children subjected to anti-cancer treatment
Dentition type
Primary dentition 10
Mixed dentition 30
Permanent dentition 25
Total 65
Results
Number of children (N)
Clinical evaluation
The incidence of caries in the studied population of children
after combined chemo-radiotherapy was high and approached
100 %. Oral hygiene in the whole group studied was considered
adequate (mean OHI-S score = 1,88), while in the subgroup
of children with primary teeth oral hygiene was poor
(mean OHI-S score = 2,25) (Table 3).
An analysis of severity of caries is presented in Table
4. The mean dmf score was 14,6; 7,06 and 6,0 in subgroups of
children with primary, mixed and permanent teeth respectively,
indicating extremely severe caries both in primary and in permanent
dentition. In all subgroups, the proportion of primary
and permanent teeth with active caries were a significant component
of the mean score of dmf and DMF indices.
An analysis of treatment indices, both for primary and
for permanent teeth, showed significant neglect concerning
both treatment and prevention (Table 5). Obtained values were
very small, ranging from 0,02 to 0,43, depending on sex and
type of dentition.
In the area of dental therapeutic requirements (Table 6), the
need for conservative treatment significantly outnumbered all
other parameters. On the basis of proportion of teeth with active
caries, need for conservative treatment was observed in
71,42 % of teeth in the subgroup of children with primary dentition,
in 48,82 % of primary teeth and 89.,10 % of permanent
teeth in the subgroup with mixed dentition and in 95,22 % of
teeth in the subgroup of children with permanent dentition.
In the subgroup of children with primary dentition, the
mean number of teeth with active caries was 13,3 out of 20,0
teeth examined, where the mean number of teeth qualifying
for extraction was 3,8 (Table 7). In children with permanent
dentition, the mean number of teeth with caries was 10,88 out
of 26,88 teeth examined and the mean number of teeth qualified
for extraction was 0,52. In the subgroup of children with
mixed dentition, mean numbers of teeth with active caries and
teeth qualified for extraction were elevated too. Interpretation
of results obtained in this subgroup is difficult due to on-going
process of exchange of dentition.
Non-caries-mediated enamel defects were noted in 49
children (75,38 % of the whole group) (Table 8). The proportion
of children with non-caries-mediated enamel defects were
70,0 %, 76,6 % and 76,0 % in the subgroups of children with
primary, mixed and permanent dentition, respectively. Noncaries-mediated
enamel defects were located on buccal or labial
surfaces, in pericervical area or encompassed more than
one tooth surface. However, most non-caries-dependant defects
were localized on labial or buccal surfaces, taking the
form of white-smooth (173 out of 229 lesions seen in 39 subjects)
or rusty-rough patches (156 out of 254 lesions seen in
33 subjects). Enamel defects were noticed in 22 patients. Labial
or buccal location of lesions was seen in 104 out of 182
lesions (Table 8).