Effects of doxorubicin on human dental pulp cells in vitro

Antineoplastic therapy in childhood cancer patients presents a negative impact in the periodontal tissues: a cohort study

OBJECTIVES

To investigate the effect of antineoplastic therapy (AT) in the periodontal tissues of childhood cancer (CC) patients.

MATERIALS AND METHODS

Seventy-two individuals were divided into CC (n=36) and healthy individuals (control group-CG, n=36). Demographics, hygiene habits, CC type, and AT were collected. Salivary flow and the presence and concentration of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Fusobacterium nucleatum were analyzed. Clinical evaluation included plaque (PI) and gingival indexes (GI), periodontal probing depth (PPD), and clinical attachment level (CAL). Patients were classified into periodontal health, gingivitis, or periodontitis. Descriptive statistics, T test, Mann-Whitney test, chi-square, Fisher's exact test, and two-way analysis of variance were used (p<0.05).

RESULTS

The mean age of the patients was similar (CC 12.0±3.9 years and CG 12.0±4.0 years). In the CC group, all patients underwent chemotherapy and nine radiotherapy. Color/race, income, and family education showed significant differences between groups. There was no difference between groups in salivary flow. Higher levels of Fusobacterium nucleatum were seen in CC (p=0.02). Significant difference between groups was found for PI (CC: 30.5%, CG: 22.6%), GI (CC: 28.8%, CG: 17.3%), PPD (CC: 1.77 mm, CG: 1.61 mm), and CAL (CC: 1.77 mm, CG: 1.57 mm), periodontal health (CC: 3, CG: 7), gingivitis (CC: 16, CG: 24), or periodontitis (CC: 17, CG: 5).

CONCLUSION

AT in CC patients presents a negative impact in the periodontal and microbiological parameters.

CLINICAL RELEVANCE

Childhood cancer individuals showed worse periodontal parameters and higher levels of Fusobacterium nucleatum in the saliva when compared to healthy individuals.

Dental Caries in Children and Adolescents During and After Antineoplastic Chemotherapy

OBJECTIVE

To assess caries incidence, intensity, and treatment in children and adolescents under/after antineoplastic treatment.

STUDY DESIGN

Patients with permanent and mixed dentition were divided into three groups of 60 patients each (5-18 years): CH - under chemotherapy; PCH - after chemotherapy; CG - generally healthy subjects. Caries incidence, intensity (DMFT/dmft, DMFS/dmfs), and mean numbers of teeth/surfaces with white spot lesions-WSL (D₁₊₂/d₁₊₂) were assessed following the ICDAS-II criteria.

STATISTICAL ANALYSIS

Mann-Whitney U test, significance at p≤0.05).

RESULTS

Caries incidence was significantly higher in PCH and CH (88.33% and 90%) than in CG (66.66%). Caries intensity was higher in both mixed and permanent dentition in patients under and after chemotherapy. The DMFS/DMFT correlation was the highest in PCH. Treatment indexes for primary and permanent teeth treatment were significantly lower in PCH and CH than CG.

CONCLUSION

Antineoplastic chemotherapy is associated with caries development and its high incidence during/after treatment. As dental hygiene was poor in patients under and after antineoplastic treatment, dental checkups need to be more frequent and thorough.

Antineoplastic chemotherapy and congenital tooth abnormalities in children and adolescents

AIM OF THE STUDY

Chemotherapeutic treatment in children and adolescents carries a risk of congenital tooth disorders and dentinoma. Study objective is to assess the correlation between tooth abnormalities, early complications of multidrug chemotherapy, and chemotherapeutics used in different antineoplastic therapies in children and adolescents.

MATERIAL AND METHODS

Enamel defects (developmental defects of enamel index - DDE index) and defects in tooth number, size, and structure were assessed clinically and radiologically in 60 patients who underwent chemotherapy on average 4.9 ±3.4 years earlier (PCH), and 60 generally healthy subjects (control group - CG), aged 6-18 years. Höltta's defect index (DeI) was calculated. Medical files provided information on neoplasm type, age at treatment start and chemotherapy duration, chemotherapeutic type and dose, vomiting, and mucositis (CTCAE v4.0). Statistical significance of differences between groups was assessed with the Mann-Whitney U test and the correlation between dental defects and chemotherapy with Spearman's rank correlation coefficient (significance p ≤ 0.05).

RESULTS

Enamel defects, tooth agenesis, microdontia, root resorption, taurodontism, and dentinoma occurred statistically significantly more often in the PCH group. A correlation was established between vincristine use and dose and all types of dental defects; cyclophosphamide, doxorubicin, and isophosphamide and hypodontia; microdontia, root resorption, and enamel defects; etoposide and cisplatin and microdontia, root resorption, and enamel defects; methotrexate root resorption and enamel defects; carboplatin and dentinoma and enamel defects. Mucositis and vomiting promoted root resorption, microdontia, and enamel defects.

CONCLUSIONS

Dental defects are related to both the use of respective chemotherapeutics, especially vincristine, cyclophosphamide, doxorubicin, and isophosphamide, and to early complications in multidrug chemotherapy - mucositis and vomiting. Vincristine and carboplatin use may promote dentinoma.

Association of cyclophosphamide use with dental developmental defects and salivary gland dysfunction in recipients of childhood antineoplastic therapy

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.

Toxicity potentiation by H2O2 with components of dental restorative materials on human oral cells

Toxicity potentiation of two monomers [bisphenol-A-glycidyldimethacrylate (BisGMA) and urethanedimethacrylate (UDMA)] as well as two comonomers [triethyleneglycoldimethacrylate (TEGDMA) and 2-hydroxyethylmethacrylate (HEMA)], each in combination with H(2)O(2), was investigated on the viability on human gingival fibroblasts (HGF) and human pulpal fibroblasts (HPF). The applied concentration of H(2)O(2) was 0.06 or 0.1 mmol/l, respectively, corresponding to the EC(0) of H(2)O(2) in HGF or HPF. The cell viability was assessed by the XTT test. From this test the half maximum effect concentrations (EC(50)) were calculated from fitted sigmoidale curves. EC(50) values were (HGF; mmol/l; mean +/- s.e.m.; n = 5): HEMA 11.9 +/- 0.9, TEGDMA 3.7 +/- 0.3, H(2)O(2) 0.36 +/- 0.04, UDMA 0.27 +/- 0.08, and BisGMA 0.11 +/- 0.03. No significant (P < 0.05) differences in the EC(50) values were observed when HGF was exposed to substances, as compared to HPF. No significant decrease of the EC(50) values was found when HGF or HPF, respectively, was exposed to HEMA or BisGMA in addition with H(2)O(2) up to the concentration of 0.1 mmol/l, as compared to those EC(50) values of each compound without H(2)O(2) addition. A significant decrease of the TEGDMA EC(50) value from 3.7 to 2.1 or 0.4 mmol/l, respectively, was found when cells were exposed to TEGDMA in combination with H(2)O(2) (0.06 or 0.1 mmol/l), as compared to that TEGDMA EC(50) value without H(2)O(2) addition. A significant decrease of the UDMA EC(50) value from 0.27 to 0.11 or 0.08 mmol/l, respectively, was found when HGF or HPF was exposed to UDMA in combination with H(2)O(2) (0.06 or 0.1 mmol/l), as compared to that UDMA EC(50) value without H(2)O(2) addition. The addition of H(2)O(2) (0.06 or 0.1 mmol/l) resulted in a toxicity potentiation of TEGDMA and UDMA, but not of HEMA and BisGMA, on HGF or HPF.