Shum Matthew, Mahoney Erin, Naysmith Kate, Macfarlane Scott, Corbett Rob, Narsinh Manisha, Natarajan Arun, Ramadas Yaso, Hitchings Elizabeth, Anderson Heather
Associate Dentist, Bishop's Dental Surgery, Hawkes Bay.
Paediatric Dentist and Hon. Clinical Senior Lecturer, Dental Department and Faculty of Paediatrics, Hutt Valley DHB and University of Otago, Wellington.
N Z Med J. 2020 Oct 9;133(1523):41-54.
The aim of this study was to determine the prevalence of dental developmental disturbances in long-term survivors of childhood malignancies in New Zealand children. This study reports associations with potential risk factors to inform oncologists and dentists of the likelihood of dental abnormalities.
The study population was children aged 14-16 years old who were diagnosed with cancer prior to 10 years of age. A total of 156 children were eligible, of which 59 participated in this study. The indices used in this study were Holtta's Defect Index (HDI), and Oral Health Impact Profile-14 (OHIP-14).
The prevalence of agenesis was 15.3%, microdontia 6.8% and root abnormalities 32.2%. Cyclophosphamide equivalent doses above 8,000mg/m2, stem cell therapy (SCT), and head and neck radiation therapy (HNRT) were associated with a higher mean number of teeth missing due to agenesis. SCT and HNRT were associated with a higher total HDI. A binary logistic regression was carried out to determine the odds of agenesis and found that HNRT was the main contributing factor (OR=7.7, p-value=0.04). The linear regression model found that dactinomycin and agenesis correlated with the largest mean OHIP-14.
This study found that childhood cancer survivors in New Zealand had a high prevalence of developmental dental abnormalities and it identified potential risk factors related to their cancer treatment. Inequitable access to oral rehabilitation for this patient group argues for a mechanism for consistent improved access to publicly funded dental care across district health boards in New Zealand.
本研究旨在确定新西兰儿童期恶性肿瘤长期幸存者中牙齿发育障碍的患病率。本研究报告了与潜在风险因素的关联，以便告知肿瘤学家和牙医牙齿异常的可能性。
研究人群为10岁前被诊断患有癌症的14至16岁儿童。共有156名儿童符合条件，其中59名参与了本研究。本研究使用的指标是霍尔塔缺陷指数（HDI）和口腔健康影响概况-14（OHIP-14）。
先天性缺失的患病率为15.3%，过小牙为6.8%，牙根异常为32.2%。环磷酰胺等效剂量超过8000mg/m²、干细胞治疗（SCT）和头颈部放射治疗（HNRT）与因先天性缺失导致的平均缺牙数较多有关。SCT和HNRT与较高的总HDI有关。进行二元逻辑回归以确定先天性缺失的几率，发现HNRT是主要促成因素（OR=7.7，p值=0.04）。线性回归模型发现放线菌素与先天性缺失与最大的平均OHIP-14相关。
本研究发现，新西兰儿童癌症幸存者牙齿发育异常的患病率很高，并确定了与其癌症治疗相关的潜在风险因素。该患者群体在获得口腔修复方面存在不平等现象，这表明需要建立一种机制，以持续改善新西兰各地区卫生委员会为其提供的公共资助牙科护理服务。
