The importance of regular dental treatment in patients with cyclic neutropenia. Follow-up of 2 cases.

Data on two patients with cyclic neutropenia are presented. They demonstrate that regular tooth care and professional dental treatment can prevent progressive periodontal breakdown but that neglecting oral hygiene soon leads to periodontal pathology. Regular, monthly professional removal of dental plaque and calculus, and rinsing with 0.2% chlorhexidine gluconate during neutropenia help maintain periodontal attachment level. The caries susceptibility and the apical periodontitis in the intact anterior tooth of the female patient indicate the possibility of cyclic neutropenia playing a role in caries and pulpal pathology.

Prevalence and location of enamel opacities in children after anti-neoplastic therapy.

The prevalence and location of enamel opacities was recorded in 37 subjects from low-fluoride areas who had received anti-neoplastic therapy and was compared with an equal number of healthy controls. All the patients had received combination chemotherapy for a malignant disease for at least 2 yr early on in their lives. These cases, and especially those with leukemia, had more opacities than the controls, although these opacities were mild in form. The results show that childhood cancer and/or the therapy provided for this can affect the developing dentition, involving all teeth in leukemia cases and the permanent teeth of the mixed dentition period in other cancer diseases.

Effect of the antineoplastic agents doxorubicin and methotrexate on rat caries and secondary dentin formation.

Because childhood cancer and/or its therapy is known to increase both dental caries and developmental defects in enamel, this experimental study was carried out to obtain information on the effect of two frequently used anticancer drugs, doxorubicin and methotrexate, on fissure caries and dentinal metabolism in healthy rats. Both drugs significantly reduced caries prevalence in the rat molars, the dentinal lesions that developed also being smaller than in the controls. Secondary dentin formation was slightly reduced, probably because of the lower caries prevalence in the rat molars and/or because of the action of the drugs. Thus, these two drugs could scarcely have been the reason for the increased caries activity in cancer patients.

Developmental defects of teeth in survivors of childhood ALL are related to the therapy and age at diagnosis.

The relation of the therapy used and age at diagnosis to developmental defects of dental enamel and root was analyzed in 45 survivors of childhood acute lymphoblastic leukemia (ALL) and compared to that of age- and sex-matched healthy controls. Chemotherapy alone increased the number of enamel defects, but it did not affect the roots. The scattered irradiation of 0.72-1.44 Gy to the dental arches during central nervous system (CNS) irradiation caused an increased number of developmental defects both in enamel and root. Age at diagnosis is an important factor and it showed that the irradiation of 10 Gy did not cause enamel defects if amelogenesis was complete. In conclusion, the therapy is related to developmental defects of the teeth but the most important factor is age, both at diagnosis and during the therapy.

Incidence of dental caries in children with acute lymphoblastic leukemia is related to the therapy used.

Dental caries is an infectious disease and it may be harmful for children suffering from leukemia. DMFS, DMFT scores of forty-five children with acute lymphoblastic leukemia (ALL) were significantly higher than in healthy age-and-sex-matched controls after cessation of therapy. The children with CNS irradiation had higher DMFT (7.13 than children with only chemotherapy (3.4) and the controls (1.8). Lifelong caries incidence showed that children with ALL had 2.7 new caries lesions per year during the therapy compared to the 1.1 (p < 0.05) new lesions in controls. More detailed analysis of permanent anterior teeth at the age of twelve years showed that all patient groups had more filled anterior teeth than controls (p < 0.001); and children with bone marrow transplantation had significantly more fillings than the other two groups.

The risk of dental caries in childhood cancer is not high if the teeth are caries-free at diagnosis.

The aim of this work was to evaluate whether the cancer itself, age, sex, number of days of fever, and septic and fungal episodes affect the salivary samples and to assess the frequency of the development of caries during cancer. The background features for caries challenge were studied by monitoring changes in counts of salivary lactobacilli and candida for up to 1 year in 36 children during anti-cancer therapy (18 leukemias and 18 solid tumors). The first dental examination was performed at the diagnosis of cancer and a reexamination about 3 years later. The results showed that the children with active caries at the diagnosis of cancer had significantly more positive findings of lactobacilli and candida than did those with a sound dentition. The other background features did not affect the results. The follow-up dental examination showed that 86.7% of the children who had a caries-free dentition at the beginning of the survey were still in this state after 3 years. In conclusion, more attention should be paid to prophylaxis and dental treatment for cancer children with caries.

Influence of antineoplastic therapy on function of the masticatory system, tooth development, and cariogenic status: a case report.

Antineoplastic therapy causes developmental disturbances in the dental enamel and root if children are treated during tooth development. Increased caries activity has also been reported. The effect of anticancer therapy on the function of the masticatory system (i.e. jaws, dentition, masticatory muscles) is not well known. A case report of a 9-year-old girl with right auricular rhabdomyosarcoma is presented. She received irradiation of 50 Gy to the right auricular area and chemotherapy. A year and a half after cessation of cancer therapy, she was disease free and the clinical stomatognathic examination combined with electromyogram (EMG) registration of the masseter and temporal muscles and magnetic resonance imaging (MRI) examination of the temporomandibular joints (TMJ) revealed a strongly restricted mouth opening capacity, painful right TMJ, and flattened head of the right mandibular condyle. Muscle atrophy in the right masseter muscle was clearly visible but EMG activities of the masseter and temporal muscles, however, were higher on the right than on the left. More severe developmental defects, and worse gingival and cariological health were observed on the right side than on the left side. She developed 12 carious lesions and all the lesions were on the right maxilla or mandible or on anterior teeth. The left side was not affected. Intensive prophylactic dental care after cancer treatment is important in order to prevent caries and gingival inflammation. Stomatognathic treatment (i.e. management of occlusal and dysfunctional problems) may improve the mouth opening capacity and relieve pain.

Oral manifestations of familial hypophosphatemic rickets after phosphate supplement therapy: a review of the literature and report of case.

The patient was a seven-year-old boy with familial vitamin D-resistant hypophosphatemic rickets. His mother, and her mother, were also affected. Before phosphate treatment was introduced in the patient, an impaired incorporation of calcium, and its exchange with sodium, was thought to be the principal etiological factor in the formation of globules. Supplementation therapy then resulted in a less elevated Ca/P ratio in the root area of the affected teeth, as well as a cure for the boy's bone structure. What the therapy did not cure was the globular appearance of the dentin and the hypomineralized stripe of pulpal horn extending to the cusp tips, an apparent permanent outcome of the disease.

Salivary immunoglobulins, lysozyme, pH, and microbial counts in children receiving anti-neoplastic therapy.

Salivary immunoglobulins, lysozyme, pH, and microbial counts were determined in 55 children with cancer diseases (37 cured subjects and 18 acute ones) and 103 healthy subjects. 5-10 ml unstimulated whole saliva was collected and pH, immunoglobulins and lysozyme were measured. Chairside dip-slide cultivations were used for microbiologic cultures. Reduced salivary pH and an increased amount of lysozyme were found in the saliva of those children who had been cured of their cancer diseases, but ongoing cancer disease or the treatment provided for it reduced pH and increased the amounts of lysozyme, lactobacillus, Streptococcus mutans and some immunoglobulins. These findings suggest that children with childhood cancer may be more susceptible to dental diseases than healthy ones.

Evaluation of Gram's method of staining for the prognosis of root canal treatment in nonvital dental pulps.

An evaluation of Gram's method of staining of 601 nonvital dental pulps was performed. It gave positive results in 60.1% of the cases, the most frequent finding was gram-positive cocci. Preoperative x-ray status correlated significantly with the staining results but the size of the radiolucency did not. Previously treated teeth gave less positive staining results than other teeth. There was an obvious correlation between presence of bacteria and various complications (p < 0.001), but no differences were noted between the combinations of bacteria. The teeth that were the most resistant to complications seemed to be the lower canines. The staining results did not correlate with sex, systemic diseases, or preoperative symptoms. We believe that Gram's method of staining is a useful, rapid aid in root canal therapy, especially in complicated cases.

Odontoblast-mediated regulation of the progression of dentinal caries.

Osteoblasts and odontoblasts are both derived from the same mesenchymal cell line. Our aim was to investigate whether the processes of bone destruction and dentinal caries are biologically similar. The working hypothesis was that after the initiation of caries in the enamel, its rate of progression in the dentine is regulated by cell-mediated factors. Experimental caries was induced in the rat with a high sucrose diet combined with Streptococcus sobrinus infection. Both destruction of dentine and its apposition in the pulp under the carious lesions were measured after vital staining with tetracycline. Caries progression and dentine apposition were higher in developing teeth prior to apex "closure" than in adult, fully-formed teeth. Rats placed on a cariogenic diet during tooth development had an increased rate of caries progression. Fluoride administration via the drinking water was associated with decreased dentine apposition and little progression of dentine caries during the developmental stages. Dentine apposition was enhanced in adult rats placed on fluoride administration, while caries progression was reduced, whereas in animals subjected to metabolic acidosis dentine caries progression was enhanced, with reduced dentine apposition. In contrast, alkalotic animals had less dentinal lesions and smaller ones than the controls. Three theories are advanced to explain the observed changes: (i) They may be associated with changes in alkaline phosphatase activity in the pulpo-dentinal complex, (ii) they may be mediated by ionic changes in the dentinal fluid, or (iii) they may reflect the liberation of growth factors from dentinal matrix.

Effect of low-dose glucocorticoid treatment on dentin formation and dentinal caries in rats.

The effect of a low dose of glucocorticoids on dentin formation and progression of dental caries was studied in young rats. The animals were inoculated in the mouth with Streptococcus sobrinus and fed ad libitum a high-sucrose, a high-starch, or a reference diet. The cortisone or placebo pellet was implanted subcutaneously in the back of the necks of the animals. After a 6-week experimental period the areas of dentin formation and dentinal caries were quantified planimetrically. Schiff's staining was used to classify caries. Cortisone reduced the dentin formation both in high-starch and reference diets, but it did not further affect the reducing effect of the high-sucrose diet on dentin formation. Cortisone did not affect the number or severity of dentinal carious lesions.

Leaving the pulp chamber open for drainage has no effect on the complications of root canal therapy.

In this retrospective study the effects of different kinds of emergency treatments on flare-ups and other complications were examined. A total of 197 teeth received emergency treatment after diagnosis at the beginning of the root canal therapy; in 103 the pulp chamber was left open for drainage of pus, 35 were treated with dexamethasone sodium phosphate, and 59 with various other medicaments, followed by routine root canal treatment. In all, 404 teeth received root canal treatment without emergency treatment. If symptoms occurred during treatment, flare-up was said to be present. If a periapical radiolucency was found, long-term calcium hydroxide treatment was used: no sign of periapical healing radiographically after 6 months was described as a complication. The percentage of teeth with no complications varied from 72.2% (dexamethasone) to 78.9% (other modification) and the results showed no differences between the groups in the teeth with no complications, flare-ups or other complications. The number of bacteria detected with Gram's staining was higher in the teeth which were left open. In conclusion, leaving the pulp chamber open for drainage had no effect on the incidence of flare-ups or other complications.