Supportive Care in Cancer

, Volume 24, Issue 4, pp 1497–1506 | Cite as

Dental abnormalities after chemotherapy in long-term survivors of childhood acute lymphoblastic leukemia 7–40 years after diagnosis

  • Petter WilbergEmail author
  • Adriani Kanellopoulos
  • Ellen Ruud
  • Marianne Jensen Hjermstad
  • Sophie Dorothea Fosså
  • Bente Brokstad Herlofson
Original Article



Factors associated with the long-term dental effects after chemotherapy for childhood malignancies have not been well described. The primary aims of this study were as follows: (1) to assess whether age at diagnosis and treatment-related factors are associated with dental defects in survivors of childhood acute lymphoblastic leukemia (ALL) and (2) to assess the survivors’ annual expenses for dental treatment compared to reference data.


This cross-sectional study enrolled 111 Norwegian survivors of ALL diagnosed before the age of 16. All of the subjects completed a questionnaire and underwent medical and oral examinations. Dental defects were registered according to the individual defect index, with 0 = no defects and 140 = anodontia, and the caries experience was registered according to the decayed-missing-filled teeth index (DMFT). Age-matched reference data were drawn from a national general population survey (n = 555).


The mean age at examination was 29.1 years (SD 7.2), and mean follow-up period was 22.9 years (SD 7.3). In a regression model, diagnoses occurring at ≤5 years of age (B = −9.6, p < 0.001) and a cumulative dose of anthracyclines >120 mg/m2 (B = 11.5, p < 0.001) were strongly associated with more severe dental defects. Survivors treated after the age of 5 had experienced more caries than those treated at a younger age [DMFT 9.6 (SD 6.1) vs. 6.0 (SD 4.6), respectively; p = 0.001]. High annual expenses for dental treatment were reported by a larger percentage of the reference population compared to the survivor group (18 vs. 9 %, respectively; p = 0.02).


The age at diagnosis and the dose of anthracyclines appear to be strongly associated with the severity of dental defects, although few survivors reported high annual expenses for dental treatment. The increased risk of dental defects during adulthood should be communicated to ALL survivors.


Acute lymphoblastic leukemia Long-term survivors Tooth abnormalities Health care costs Dental caries 



We would like to thank Julie Brandvik, DDS, and Betina Adriana Lind van Pelt, DDS, for measuring the roots and crowns of all the teeth; Dr. Med. Alv A. Dahl, MD, Anna-Marie Thorndall Ryenbakken, and Bernward Zeller, MD, PhD, for their practical help during and after the study period; and Dr. Philos Leiv Sandvik for his assistance with the statistical analysis.

This study received financial support from the Norwegian Cancer Society (grant numbers 59030001 and 59032001) and from Helse SørØst HF (grant number 2009016). We thank these institutions for their gracious support of our research.

Some of the data applied in the analysis of this publication are based on “Level of living 2008 - Cross sectional study – Health.” This survey was financed by the Norwegian Directorate of Health, University of Oslo; Ministry of Children and Equality; the National Centre for Documentation on Disability; and the National Research Center in Complementary and Alternative Medicine. The data were provided by Statistics Norway and prepared and made available by the Norwegian Social Science Data Services (NSD). Statistics Norway, the Norwegian Directorate of Health, the University of Oslo, the Ministry of Children and Equality, the National Centre for Documentation on Disability, The National Research Center in Complementary and Alternative Medicine and NSD are not responsible for the analysis and interpretation of the data presented here.

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Petter Wilberg
    • 1
    Email author
  • Adriani Kanellopoulos
    • 2
    • 3
  • Ellen Ruud
    • 2
  • Marianne Jensen Hjermstad
    • 4
    • 5
  • Sophie Dorothea Fosså
    • 6
  • Bente Brokstad Herlofson
    • 1
  1. 1.Department of Oral Surgery and Oral Medicine, Faculty of DentistryUniversity of OsloOsloNorway
  2. 2.Department of Paediatric Medicine, Women and Children’s DivisionOslo University Hospital, RikshospitaletOsloNorway
  3. 3.Faculty of MedicineUniversity of OsloOsloNorway
  4. 4.Regional Centre for Excellence in Palliative Care, Department of OncologyOslo University Hospital, UllevålOsloNorway
  5. 5.European Palliative Care Research Centre, Faculty of Medicine, Department of Cancer Research and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
  6. 6.National Resource Centre for Late Effects After Cancer Treatment, Department of OncologyOslo University Hospital, RadiumhospitaletOsloNorway

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