37 - Dental Developmental Defects in Survivors of Childhood Acute Lymphoblastic Leukemia

Purpose: To describe the frequency of tooth developmental anomalies as measured through Holtta’s Defect Index (HDI) in survivors of childhood acute lymphoblastic leukemia (ALL), as a function of age at diagnosis.

Methods: This case-controlled, retrospective chart review evaluated panoramic radiographs of patients treated for ALL by the Dana-Farber Cancer Institute (protocols 05-001 and 11-001) and seen in the Boston Children’s Hospital Department of Dentistry. Of the 299 patients treated, 21 patients’ who had a panoramic radiograph following oncology treatment were reviewed using the HDI. The HDI comprises 3 components: tooth aplasia, microdontia, and root/crown ratios. From the panoramic radiograph, each tooth was evaluated and given a score based on the severity of defect present.

Results:  Average age at ALL diagnosis was 4.3 years (range 1-15). Ten patients (48%) demonstrated root-crown ratio defects, 10 (48%) had at least one microdont, and 2 (9%) presented with agenesis of teeth. Compared to healthy age/gender matched controls, only 2 of 20 (10%) demonstrated any of the 3 measured defects. Patients under 3 years at cancer diagnosis had an average HDI of 10.3, compared to patients diagnosed at ≥ 4 years, had an average HDI of 8.9. Root-crown ratio defects were significantly higher in the study population (P >.004).

Conclusions: Oncology treatment (chemotherapy, cranial radiation, and other care) may result in long-term dental developmental defects, including microdontia, agenesis, and root/crown ratio defects. Future studies should continue to assess these defects, and evaluate their incidence with more modern oncology treatments.

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