Disturbed root development of permanent teeth after pediatric stem cell transplantation

BACKGROUND Deficient dental root development has been reported after conventional pediatric anticancer therapy, but less information is available on stem cell transplantation (SCT) recipients. METHODS Root‐crown (R/C) ratios of fully developed permanent teeth were assessed from panoramic radiographs of 52 SCT recipients, who were treated when they were age < 10 years. Using standard deviation scores (SDSs), the authors compared the R/C ratios to the corresponding tooth and gender‐specific values in a healthy population. The percentage of affected R/C ratios per individual was examined in a subgroup of 39 (SG39) patients with advanced tooth development. The effects of total body irradiation (TBI) and SCT age on the R/C ratios were studied in TBI and high‐dose chemotherapy (HDC = non‐TBI) groups and in 3 age groups (≤ 3.0 years, 3.1–5.0 years, ≥ 5.1 years). RESULTS Per individual, 77% of the fully developed permanent teeth were affected in SG39. At the tooth level, in 77% of the 945 teeth studied (52 patients), the R/C ratios were outside ±2 SDSs. More teeth were affected in the TBI (85%) than in the non‐TBI (55%) group (P < 0.001). The teeth of the patients who were ages 3.1–5.0 years old at SCT presented with the most severe aberrations of the R/C ratio (mean SDS = −4.4) whereas the teeth of the youngest (age ≤ 3.0 years) and the oldest (age ≥ 5.1 years) patients were equally affected (mean SDSs = −3.1 and −3.0, respectively). CONCLUSIONS Disturbances of dental root growth always followed pediatric SCT. HDC alone intensely harmed root growth but TBI further increased the adverse effects that were most extensive in the patients 3.1–5.0 years at SCT. These sequelae should be taken into account during the lifelong dental follow‐up to minimize the clinical consequences of dental injuries. Cancer 2005. © 2005 American Cancer Society. Pediatric recipients of stem cell transplantation (SCT) had root‐crown ratios outside ±2 standard deviation scores in almost 80% of their permanent teeth. High‐dose chemotherapy alone intensely harmed root growth but total body irradiation further increased the adverse effects that were most extensive in patients 3.1–5.0 years at SCT.