title: Association of cyclophosphamide use with dental developmental defects and salivary gland dysfunction in recipients of childhood antineoplastic therapy.
abstract: BACKGROUND
  The aim of this study was to examine the effect of antineoplastic therapy on dental development and saliva function in recipients of childhood antineoplastic therapy.
  
  
  METHODS
  Patients attending the long-term follow-up clinic at Children's Hospital at Westmead, NSW, Australia, were included if they had received treatment prior to 16 years of age and were in remission for more than 5 years. A dental examination and saliva test were performed for each participant. Holtta's Defect Index (HDI) was used to assess tooth aplasia, microdontia, and root-crown ratio on an orthopantomogram (OPG). Multivariable-adjusted regression analyses were used to estimate the association of patient characteristics and treatment modalities with dental outcomes.
  
  
  RESULTS
  One hundred six participants (61% male) were recruited (response rate = 88%). The mean HDI score was 24.7 ± 17.8. A cumulative dose of cyclophosphamide >7500 mg/m(2) increased the HDI score by 13.06 (P = .01). Recipients of cyclophosphamide also had significantly increased odds of exhibiting very low saliva flow (<0.7 mL/min) (odds ratio = 12.43; 95% confidence interval, 2.08-74.35; P = .006).
  
  
  CONCLUSIONS
  Children and adolescents who received high doses of cyclophosphamide were at increased risk of dental disturbances. Cyclophosphamide recipients were also at greater risk of exhibiting very low saliva flow. This study applied the HDI to patients receiving all forms of antineoplastic treatment and highlights the dose-dependent relation between cumulative dose of cyclophosphamide and dental disturbances.
authors.affiliation: Westmead Centre for Oral Health, Children's Hospital at Westmead, Westmead, Australia. susan.hsieh@gmail.com
authors.forename: Susan Gyea-Su
authors.initials: SG
authors.lastname: Hsieh
authors.forename: Sally
authors.initials: S
authors.lastname: Hibbert
authors.forename: Peter
authors.initials: P
authors.lastname: Shaw
authors.forename: Verity
authors.initials: V
authors.lastname: Ahern
authors.forename: Manish
authors.initials: M
authors.lastname: Arora
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000009:adverse effects*; D003731:Dental Caries / Q000453:epidemiology; D009063:Dental Physiological Phenomena / Q000187:drug effects*; D006801:Humans; D008297:Male; D012466:Salivary Gland Diseases / Q000139:chemically induced*; D014070:Tooth / Q000187:drug effects / Q000254:growth & development*; D014071:Tooth Abnormalities / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents; D003520:Cyclophosphamide