title: Dental abnormalities after chemotherapy in long-term survivors of childhood acute lymphoblastic leukemia 7-40 years after diagnosis.
abstract: OBJECTIVE
  Factors associated with the long-term dental effects after chemotherapy for childhood malignancies have not been well described. The primary aims of this study were as follows: (1) to assess whether age at diagnosis and treatment-related factors are associated with dental defects in survivors of childhood acute lymphoblastic leukemia (ALL) and (2) to assess the survivors' annual expenses for dental treatment compared to reference data.
  
  
  METHODS
  This cross-sectional study enrolled 111 Norwegian survivors of ALL diagnosed before the age of 16. All of the subjects completed a questionnaire and underwent medical and oral examinations. Dental defects were registered according to the individual defect index, with 0 = no defects and 140 = anodontia, and the caries experience was registered according to the decayed-missing-filled teeth index (DMFT). Age-matched reference data were drawn from a national general population survey (n = 555).
  
  
  RESULTS
  The mean age at examination was 29.1 years (SD 7.2), and mean follow-up period was 22.9 years (SD 7.3). In a regression model, diagnoses occurring at ≤5 years of age (B = -9.6, p < 0.001) and a cumulative dose of anthracyclines >120 mg/m(2) (B = 11.5, p < 0.001) were strongly associated with more severe dental defects. Survivors treated after the age of 5 had experienced more caries than those treated at a younger age [DMFT 9.6 (SD 6.1) vs. 6.0 (SD 4.6), respectively; p = 0.001]. High annual expenses for dental treatment were reported by a larger percentage of the reference population compared to the survivor group (18 vs. 9 %, respectively; p = 0.02).
  
  
  CONCLUSIONS
  The age at diagnosis and the dose of anthracyclines appear to be strongly associated with the severity of dental defects, although few survivors reported high annual expenses for dental treatment. The increased risk of dental defects during adulthood should be communicated to ALL survivors.
authors.affiliation: Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, P.O. Box 1142, Blindern, 0318, Oslo, Norway. wipe@odont.uio.no.
authors.forename: Petter
authors.initials: P
authors.lastname: Wilberg
authors.affiliation: Department of Paediatric Medicine, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Adriani
authors.initials: A
authors.lastname: Kanellopoulos
authors.affiliation: Department of Paediatric Medicine, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Ellen
authors.initials: E
authors.lastname: Ruud
authors.affiliation: Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway.|European Palliative Care Research Centre, Faculty of Medicine, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Marianne Jensen
authors.initials: MJ
authors.lastname: Hjermstad
authors.affiliation: National Resource Centre for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway.
authors.forename: Sophie Dorothea
authors.initials: SD
authors.lastname: Fosså
authors.affiliation: Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, P.O. Box 1142, Blindern, 0318, Oslo, Norway.
authors.forename: Bente Brokstad
authors.initials: BB
authors.lastname: Herlofson
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D017741:Survivors; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Acute lymphoblastic leukemia; Dental caries; Health care costs; Long-term survivors; Tooth abnormalities