Annals of Diagnostic Paediatric Pathology

More documents

Recommendations

Info

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. References 1. Cioch M (2001) Uszkodzenie bariery sluzówkowej (Mucosal barier injury- MBI) w nastêpstwie intensywnego leczenia cytostatycznego. Onkol Pol 4,2: 85-89 (in Polish) 2. Darczuk D (1999) Zmiany w jamie ustnej wywo³ane napromienianiem nowotworów g³owy i szyi. Stomat Wspó³czesna 6,1:23-25 (in Polish) 3. Groetz KA, Wagner W, Duschner H (2001) Chronische Strahlenfolgen an den Zahnhartgeweben (“Strahlenkaries”). Klassifikation und Behandlungsansaetze. Strahlentherapie und Onkologie-Abstract 177,2 :96-10 4. Jaffe N, Toth BB, Hoar RE, Ried HL, Sullivan MP, McNeese M (1984) Dental and maxillofacial abnormalites in long-term survivors of childhood cancer: effects of treatment with chemotherapy and radiation to the head and neck. Pediatrics 73,6:816-823 5. Jankowska K (1992) Próchnica popromienna (opis przypadku). Wroc³awska Stomatologia 235-238 (in Polish) 6. Macleod RI, Welbury RR, Soames J (1987) Effects of cytotoxic chemotherapy on dental development. J Royal Soc Med 80:207-209 7. Maguire A, Welbury R (1996) Long-term Effects of antineoplastic chemotherapy and radiotherapy on dental development. Dental Update 23 (5):188-194 8. Manguire A, Craft AW, Evans RGB, Amineddine H, Kehrnahan J, Macleod RI (1987) Long-term effects of treatment on the dental condition of children surviving malignant disease. Cancer 60:2570-2575 9. Markitziu A, Zafiropolos G, Tsalikis L, Cohen L (1992) Gingival health and salivary function in head- and neck– irradited patients. Oral Surg Oral Med Oral Pathol 73:427-433
10. Nunn JH, Welbury RR, Gordon PH, Kernahan J, Craft AW (1991) Dental caries and dental anomalies in children treated by chemotherapy for malignant disease: a study in the north of England. Int J Paediatr Dent 1:131-135 11. Olczak-Kowalczyk D, Dobies K, Daszkiewicz M (2002) Zastosowanie lakieru Seal & Protect w profilaktyce próchnicy popromiennej u dzieci po przebytej terapii przeciwnowotworowej. Magazyn Stomatologiczny 11,133,12:10-13 (in Polish) 12. Olczak-Kowalczyk D, Daszkiewicz M (2002) Wspó³czesne metody profilaktyki próchnicy w grupie wysokiego ryzyka jej wystêpowania. Standardy Medyczne 4,6 (32):402-411 (in Polish) 13. Olczak-Kowalczyk D, Bedra B (2003) Stan zdrowia jamy ustnej i stomatologiczne potrzeby lecznicze w badanej populacji dzieci z ryzykiem infekcyjnego zapalenia wsierdzia. Nowa Stomat 3,25:111-119 (in Polish) 14. Olczak-Kowalczyk D, Perek D, Daszkiewicz M, Adamowicz-Klepalska B, Dembowska-Baginska B, Daszkiewicz P (2003) Problemy stomatologiczne u dzieci z chorobami nowotworowymi. Doœwiadczenia wlasne. Nowa Stomat 4;26:175-179 (in Polish) 15. Rosenberg SW, Kolodney H, Wong GY, Murphy ML (1987) Altered dental root development in long-term survivors of pediatric acute lymphoblastic leukemia. A review of 17 cases. Cancer 59:1640-1648 16. Welbury RR, Craft AW, Murray JJ, Kehrnahan J (1984) Dental health of survivors of malignant disease. Archiv Dis Child 59:1186-1188
Page 1 and 2: Annals of Diagnostic Paediatric Pat
Page 5 and 6: 71 Until recently, it has been assu
Page 9 and 10: 75 Age In his original paper of 198
Page 11 and 12: 77 4. Ganglioneuroblastoma, Nodular
Page 13 and 14: 79 Table 1 International Neuroblast
Page 15 and 16: 81 receive chemotherapy if the hist
Page 19 and 20: 85 Table 1 Comparison between epend
Page 21 and 22: 87 nancy in ependymomas [7, 21]. Op
Page 25 and 26: 91 Fig. 2 Liver biopsy of patient n
Page 27 and 28: 93 especially typical for LCHAD def
Page 29 and 30: 96 The aim of our study was to comp
Page 31 and 32: References 1. Adams MC, Mitchell ME
Page 33 and 34: 100 available literature. Enamel is
Page 35 and 36: 102 Table 3 Correlation of oral hyg
Page 37: 104 Table 7 Total mean number of te
Page 41 and 42: 108 Introduction In the last 15 yea
Page 43 and 44: Table 3 Characteristics of surgical
Page 45 and 46: 0000000000000000000 000000000000000
Page 49 and 50: 117 Fig. 2 Dubin-Johnson syndrome:
Page 55 and 56: 123 Discussion Preoperative diagnos
Page 57 and 58: 126 hemangioendotheliomas occured i

Annals of Diagnostic Paediatric Pathology

Create successful ePaper yourself

Delete template?

Save as template?