Annals of Diagnostic Paediatric Pathology

105
Electron-microscopic examination
Scanning electron microscopical analysis of the enamel of teeth
showed its lack or crack in number of areas. Derangement of
enamel prisms and their clump was observed (Fig.1). No alterations
of the pattern of dentin canals were noticed (Fig.2).
Discussion
Intensification of chemotherapy and it’s combination with
surgery and/or radiotherapy have made possible an increasingly
effective treatment of head and neck malignancies [1,
2]. However, such an aggressive treatment is associated with
an increased risk of many adverse side-effects, concerning
many different components of the chewing apparatus. Particularly
severe complications may accompany anticancer
treatment of children and adolescents. Anticancer treatment
proves effective in a growing number of patients, resulting in
longer survival time. This in turn contributes to an increased
incidence of late adverse effects of therapy, e.g. destruction of
mineralized tissues of teeth and various developmental abnormalities
of chewing apparatus [3, 4, 5]. Therefore, oral care
professionals will be increasingly often confronted by such
problems. Unfortunately, available literature provides little data
concerning dental problems in patients undergoing anticancer
treatment in childhood or guidelines for their effective
prophylactic, therapeutic and rehabilitative management.
Results of clinical trials indicate significant hygienic
neglect and poor dentition status of children subjected to chemotherapy
combined with radiotherapy. We noticed alarmingly
high incidence of caries and it’s extreme severity. In our
study, the mean dmf score was 14,6, largely exceeding values
observed in children in the risk group for infectious endocarditis,
where dmf score was 9,25 and DMF score was 10,42, as
well as in children undergoing chemotherapy alone, where it
equaled to 2,5 and 14,1 respectively [13]. We have noticed a
large disproportion between requirements for dental treatment
and dental treatment actually carried out. Values of treatment
indices in children after anticancer treatment and those in the
risk group for infectious endocarditis were similar, in the range
of 0-0,34 and 0,03-0,34 respectively.
An analysis of the scope of required dental treatment
in children after chemotherapy combined with radiotherapy
revealed significant needs in the area of conservative treatment
and relatively smaller needs in the field of surgical treatment,
possibly indicating high speed of development of new
caries-dependent defects.
In 69 % of children analyzed we observed atypical noncaries
dependent enamel lesions in the form of patches and
enamel defects. They occurred twice as often than in children
undergoing chemotherapy alone. Children after chemotherapy
combined with radiotherapy presented mostly white, rusty or
rough patches, while children after chemotherapy alone had
usually white lesions.
Deleterious effect of radiotherapy on dentition is well known
since a long time. The so-called “post-radiation caries” in patients
undergoing radiotherapy in the area of head and neck,
is a phenomenon well established in the literature [2, 3, 5, 8,
11, 12, 14]. Observed thereby enamel defects are at the beginning
probably non-bacterial in nature and are caused by chemical
and mechanical factors acting upon a primarily more susceptible
enamel. It would seem, that subsequent development
of caries in these patients is secondary to the above described
phenomena.
Conclusions
1. High incidence and severity of caries and atypical non-caries
mediated enamel defects observed in patients subjected to
chemotherapy combined with radiotherapy in the facial region,
support the thesis about deleterious effect of anti-cancer
on dentition.
2. Significant disproportion between requirements for dental
treatment and actually performed conservative and surgical
treatment indicate, that dental prophylactic and therapeutic
management should be instituted as early as possible in these
patients.
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