mercaptopurine and Dental-Enamel-Hypoplasia

The frequency of dental abnormalities, such as delayed dental development, microdontia, hypoplasia, agenesis, V-shaped root and shortened root was evaluated in 76 acute lymphoblastic leukemia (ALL) pediatric patients who had been off chemotherapy for 6 months. These children had been subjected to one of the three Brazilian Protocols or the BFM86 Protocol. The patients were divided into three groups: Group I (GI; high risk) treated with one of the three Brazilian Protocols who received high-dose chemotherapy, intensive maintenance and cranial radiotherapy; Group II (GII; low risk) who were also treated with one of the three Brazilian Protocols using low-intensive chemotherapy with no radiotherapy; and Group III (GIII) based on the BFM86 Protocol. Of 76 children, 13 showed no dental abnormalities (8 were at the age of tooth formation). The remaining 63 children (82.9%) showed at least one dental anomaly. The abnormalities were probably caused by the type, intensity, frequency of the treatment and age of the patients at ALL diagnosis and this might have important consequences for the children's dental development.

Topics: Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Child; Child, Preschool; Combined Modality Therapy; Cranial Irradiation; Cyclophosphamide; Cytarabine; Dental Enamel Hypoplasia; Dexamethasone; Doxorubicin; Etoposide; Female; Humans; Infant; Male; Mercaptopurine; Methotrexate; Odontogenesis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Teniposide; Tooth Abnormalities; Tooth Diseases; Tooth Eruption; Tooth Root; Vincristine

Disturbances in dental development were studied with the use of radiography and histology in a patient with acute lymphoblastic leukemia who was treated with induction chemotherapy at 2.3 years of age and bone marrow transplantation at 4.3 years of age. The follow-up 9.5 years after bone marrow transplantation showed evidence of short tapered roots, enamel hypoplasia, microdontia, and aplasia. A histologic examination of two extracted permanent teeth showed that the crown of the maxillary lateral incisor exhibited numerous incremental lines that corresponded closely to the treatment periods with cytotoxic drugs. The maxillary second premolar exhibited regularly spaced incremental lines in the enamel and dentine. A gross hypoplasia was seen in the cervical part of the crown corresponding to the time of administration of 10 Gy total body irradiation. The results indicate that chemotherapy mainly induces qualitative disturbances in dentine and enamel, whereas total body irradiation induces both qualitative and quantitative changes.

Topics: Abnormalities, Radiation-Induced; Amelogenesis; Antineoplastic Agents; Asparaginase; Bone Marrow Transplantation; Child, Preschool; Cyclophosphamide; Cytarabine; Dental Arch; Dental Enamel Hypoplasia; Dentinogenesis; Doxorubicin; Female; Humans; Immunosuppressive Agents; Maxillofacial Development; Mercaptopurine; Methotrexate; Odontogenesis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Tooth Eruption; Tooth Root; Vincristine; Whole-Body Irradiation