International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 12 , ISSUE 3 ( May-June, 2019 ) > List of Articles


Long-term Adverse Effects of Acute Myeloid Leukemia Treatment on Odontogenesis in a Child

Magali Hernandez, Cécile Pochon, Pascal Chastagner, Dominique Droz

Keywords : Childhood cancer, Long-term survivors, Tooth abnormalities

Citation Information : Hernandez M, Pochon C, Chastagner P, Droz D. Long-term Adverse Effects of Acute Myeloid Leukemia Treatment on Odontogenesis in a Child. Int J Clin Pediatr Dent 2019; 12 (3):243-246.

DOI: 10.5005/jp-journals-10005-1614

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Background: Several studies showed that cancer therapies during tooth development are associated with dental abnormalities, including enamel defects, arrested tooth development, microdontic teeth, and agenesis. Study design: We describe the case of a nine-year-old boy treated for acute myeloid leukemia at 15 months of age, who presents several dental abnormalities resulting from anticancer treatment. Results: The patient was included and treated according to the ELAM 02 French protocol. Six years after allogenic hematopoietic stem cell transplantation, the intraoral and radiographic examination highlighted the agenesis of the second permanent molars and three of the four second premolars, microdontia of the first premolars, root stunting of the central incisors and first premolars, rootlessness of the first permanent molars, and enamel defects localized at the permanent incisors and canines. As a first step to reduce enamel defects, restorations with resin composite (Tetric EvoCeram® A2, Ivoclar Vivadent) were performed under a dental dam. Orthodontic treatment was contraindicated due to arrested tooth development, short roots, and a risk of resorption is considered too important. Conclusion: The young age at diagnosis (<5 years of age) and intensive chemotherapy (especially myeloablative conditioning with high doses of cyclophosphamide and Busulfan) could explain the severity of the dental abnormalities. This case illustrates the importance of systematically scheduling a dental follow-up in parallel with the onco-hematologic follow-up allowing the clinicians to prevent, detect, and propose early intervention for dental late effects.

PDF Share
  1. Marec-Berard P, Azzi D, et al. Long-term effects of chemotherapy on dental status in children treated for nephroblastoma. Pediatr Hematol Oncol 2005;22:581–588. DOI: 10.1080/08880010500198848.
  2. Maciel JCC, De Castro CG, et al. Oral health and dental anomalies in patients treated for leukemia in childhood and adolescence. Pediatr Blood Cancer 2009;53:361–365. DOI: 10.1002/pbc.22108.
  3. Preudhomme C, Llopis L, et al. Classification et facteurs pronostiques des leucémies aiguës. Encycl Med Chir Hematol 2012;17(1):1–17. DOI: 10.1016/S1155-1984(12)55654-2.
  4. Proc P, Szczepanska J, et al. Dental anomalies as late adverse effect among young children treated for cancer. Cancer Res Treat 2016;48(2):658–667. DOI: 10.4143/crt.2015.193.
  5. Gawade PL, Hudson MM, et al. A systematic review of dental late effects in survivors of childhood cancer. Pediatr Blood Cancer 2014;61:407–416. DOI: 10.1002/pbc.24842.
  6. Effinger KE, Migliorati CA, et al. Oral and dental late effects in survivors of childhood cancer: a children's oncology group report. Support Care Cancer 2014;22:2009–2019. DOI: 10.1007/s00520-014-2260-x.
  7. Van der Pas-van Voskuilen IGM, Veerkamp JSJ, et al. Long-term adverse effects of hematopoietic stem cell transplantation on dental development in children. Support Care Cancer 2009;17:1169–1175. DOI: 10.1007/s00520-008-0567-1.
  8. Schour I, Massler M. Studies in tooth development – the growth patterns of human teeth. Part 1 and 2. Amer Dent Ass 1940;27:1778–1739. DOI: 10.14219/jada.archive.1940.0340.
  9. Hsieh SG, Hibbert S, et al. Association of cyclophosphamide use with dental developmental defects and salivary gland dysfunction in recipients of childhood antineoplastic therapy. Cancer 2011;117:2219–2227. DOI: 10.1002/cncr.25704.
  10. Kaste SC, Goodman P, et al. Impact of radiation and chemotherapy on risk of dental abnormalities: a report from the childhood cancer survivor study. Cancer 2009;115:5817–5827. DOI: 10.1002/cncr.24670.
  11. Wilberg P, Kannellopoulos A, et al. Dental abnormalities after chemotherapy in long-term survivors of childhood acute lymphoblastic leukemia 7–40 years after diagnosis. Support Care Cancer 2016;24:1497–1506. DOI: 10.1007/s00520-015-2940-1.
  12. Vesterbacka M, Ringden O, et al. Disturbances in dental development and craniofacial growth in children treated with hematopoietic stem cell transplantation. Orthod Craniofac Res 2012;15:21–29. DOI: 10.1111/j.1601-6343.2011.01533.x.
  13. Holtta P, Alaluusua S, et al. Agenesis and microdontia of permanent teeth as late adverse effects after stem cell transplantation in young children. Cancer 2005;103:181–190. DOI: 10.1002/cncr.20762.
  14. Laisi S, Ess A, et al. Amoxicillin may cause molar incisor hypomineraliza-tion. J Dent Res 2009;88(2):132–136. DOI: 10.1177/0022034508328-334.
  15. Craig SA, Baker SR, et al. How do children view other children who have visible enamel defects? Int J Paediatr Dent 2015;25:399–408. DOI: 10.1111/ipd.12146.
  16. Nixon PJ, Robinson S, et al. Conservative aesthetic techniques for discolored teeth: 2 microabrasion and composite. Dent Update 2007;34:160–162. DOI: 10.12968/denu.2007.34.3.160.
  17. Children's Oncology Group. Dental health following children cancer treatment. 2013. Available at:, accessed: 2016-12-10.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.