Skip to main content
SpringerLink
Log in

Temporomandibular Joint and Dental Complications in Long-Term Survivors of Children with Leukemia after Chemoradiotherapy and Stem Cell Transplantation

  • ORIGINAL ARTICLE
  • Published:
Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

The purpose of this study was to investigate the long-term effects of chemoradiotherapy and transplantation on the temporomandibular joint (TMJ) and dental status in leukemia and stem cell transplantation (SCT) patients. The study included 44 patients and 22 controls. Participants were categorized into three groups: patients with leukemia in Group-1 (n = 22), patients with SCT in Group-2 (n = 22), and controls in Group-3 (n = 22). All patients were evaluated using the Diagnostic Criteria for TMJ Disorders (TMD), as well as clinical and radiographic assessments. TMD was found in 19 (86%) of the 22 patients in Group-1, 12 (54%) of the 22 patients in Group-2, and 4 (18%) of the 22 controls. The brushing habit was significantly lower in Group-2 than in other Groups (p < 0.05). Group-3 had significantly higher mean values for painless, maximum assisted, and unassisted mouth opening than the other Groups (p < 0.05). The rate of click and crepitation sounds was significantly higher in Group-1 and Group-2 than in Group-3 (p < 0.05). The rate of nondental pain was significantly higher in Group-1 than in other Groups (p < 0.05). The rate of disc displacement with a reduction in both TMJ was significantly higher in Group-1 than in Group-3 (p < 0.05). Radiological studies revealed flattening in at least one condyle in 9 (20%) of both Group-1 and Group-2 patients. Flattening of both condyles and thinning of the mandibular cortex due to osteoporosis were found in 2 (9%) of Group-2. Our data suggest that screening for TMD after chemoradiotherapy and SCT may be beneficial for pediatric leukemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jovičić O, Mandić J, Mandinić Z, Čolović A (2021) Oral changes in patients before and after transplantation of solid organs and hematopoietic stem cells. Srp Arh Celok Lek 149(5–6):381–386

    Article  Google Scholar 

  2. Çetiner D, Çetiner S, Uraz A, Alpaslan GH, Alpaslan C, Toygar Memikoğlu TU et al (2019) Oral and dental alterations and growth disruption following chemotherapy in long-term survivors of childhood malignancies. Support Care Cancer 27:1891–1899

    Article  PubMed  Google Scholar 

  3. Frascino AV, Coracin FL, da Silva Santos PS, Júnior LAV, Fava M, OdoneFilho V (2015) Long-term dental follow-up in hematological stem cells transplantation children. Braz Dent Sci 18(4):12–8

    Article  Google Scholar 

  4. American Academy of Pediatric Dentistry (2016) Guideline on dental management of pediatric patients receiving chemotherapy, hematopoietic cell transplantation, and/or radiation therapy. Pediatr Dent 38(6):334–342.5

  5. Glenny A, Gibson F, Auld E, Coulson S, Clarkson J, Craig J et al (2010) The development of evidence-based guidelines on mouth care for children, teenagers and young adults treated for cancer. Eur J Cancer 46(8):1399–1412

    Article  CAS  PubMed  Google Scholar 

  6. Sung L, Robinson P, Treister N, Baggott T, Gibson P, Tissing W, Wiernikowski J, Brinklow J, Dupuis LL (2017) Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing hematopoietic stem cell transplantation. BMJ Support Palliat Care 7(1):7–16

    Article  PubMed  Google Scholar 

  7. Uderzo C, Fraschini D, Balduzzi A, Galimberti S, Arrigo C, Biagi E et al (1997) Long-term effects of bone marrow transplantation on dental status in children with leukemia. Bone Marrow Transplant 20(10):865–869

    Article  CAS  PubMed  Google Scholar 

  8. Welbury R, Craft A, Murray J, Kernahan J (1984) Dental health of survivors of malignant disease. Arch Dis Child 59(12):1186–1187

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Dahllöf G, Krekmanova L, Kopp S, Borgström B, Forsberg C-M, Ringdén O (1994) Craniomandibular dysfunction in children treated with total-body irradiation and bone marrow transplantation. Acta Odontol Scand 52(2):99–105

    Article  PubMed  Google Scholar 

  10. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P et al (2014) Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 28(1):6

    Article  PubMed  Google Scholar 

  11. Girard P, Auquier P, Barlogis V, Contet A, Poiree M, Demeocq F et al (2013) Symptomatic osteonecrosis in childhood leukemia survivors: prevalence, risk factors and impact on quality of life in adulthood. Haematologica 98(7):1089

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Kim SY, Yoo DM, Kwon MJ, Kim JH, Kim J-H, Byun S-H et al (2022) Increased risk of temporomandibular joint disorder in osteoporosis patients: a longitudinal study. Front Endocrinol (Lausanne) 13:835923

  13. Kaya Z, Gursel T, Bakkaloglu SA, Kocak U, Atasever T, Oktar SO (2007) Evaluation of renal function in Turkish children receiving BFM-95 therapy for acute lymphoblastic leukemia. Pediatr Hematol Oncol 24(4):257–267

    Article  PubMed  Google Scholar 

  14. Gibson BE, Wheatley K, Hann I, Stevens R, Webb D, Hills RK et al (2005) Treatment strategy and long-term results in paediatric patients treated in consecutive UK AML trials. Leukemia 19(12):2130–2138

    Article  CAS  PubMed  Google Scholar 

  15. Organization WHO (2013) Oral health surveys: basic methods: World Health Organization, 5th edition, pp 125

  16. Gawade PL, Hudson MM, Kaste SC, Neglia JP, Constine LS, Robison LL et al (2014) A systematic review of dental late effects in survivors of childhood cancer. Pediatr Blood Cancer 61(3):407–416

    Article  PubMed  Google Scholar 

  17. Effinger KE, Migliorati CA, Hudson MM, McMullen KP, Kaste SC, Ruble K et al (2014) Oral and dental late effects in survivors of childhood cancer: a Children’s Oncology Group report. Support Care Cancer 22(7):2009–2019

    Article  PubMed  PubMed Central  Google Scholar 

  18. Halperson E, Matalon V, Goldstein G, Saieg Spilberg S, Herzog K, Fux-Noy A et al (2022) The prevalence of dental developmental anomalies among childhood cancer survivors according to types of anticancer treatment. Sci Rep 12(1):1–8

    Article  Google Scholar 

  19. da Silva CG, Pacheco-Pereira C, Porporatti AL, Savi MG, Peres MA, Flores-Mir C et al (2016) Prevalence of clinical signs of intra-articular temporomandibular disorders in children and adolescents: a systematic review and meta-analysis. J Am Dent Assoc 147(1):10–8.e8

    Article  PubMed  Google Scholar 

  20. Al-Khotani A, Naimi-Akbar A, Albadawi E, Ernberg M, Hedenberg-Magnusson B, Christidis N (2016) Prevalence of diagnosed temporomandibular disorders among Saudi Arabian children and adolescents. J Headache Pain 17(1):1–11

    Article  Google Scholar 

  21. Goodman J, McGrath P (1991) The epidemiology of pain in children and adolescents: a review. Pain 46(3):247–264

    Article  CAS  PubMed  Google Scholar 

  22. Alajbeg IZ, Gikić M, Valentić-Peruzović M (2015) Mandibular range of movement and pain intensity in patients with anterior disc displacement without reduction. Acta Stomatol Croat 49(2):119

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nilsson I-M, List T, Drangsholt M (2005) Prevalence of temporomandibular pain and subsequent dental treatment in Swedish adolescents. J Orofac Pain 19(2):144–150

  24. Poluha RL, Canales GDlT, Costa YM, Grossmann E, Bonjardim LR, Conti PCR (2019) Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation. J Appl Oral Sci 27:e20180433

  25. Pasinato F, Souza JA, Corrêa ECR, da Silva AMT (2011) Temporomandibular disorder and generalized joint hypermobility: application of diagnostic criteria. Braz J Otorhinolaryngol 77(4):418–425

    Article  PubMed  Google Scholar 

  26. Dias IM, Coelho PR, Assis NMSP, Leite FPP, Devito KL (2012) Evaluation of the correlation between disc displacements and degenerative bone changes of the temporomandibular joint by means of magnetic resonance images. Int J Oral Maxillofac Surg 41(9):1051–1057

    Article  PubMed  Google Scholar 

  27. Powell C, Chang C, Naguwa SM, Cheema G, Gershwin ME (2010) Steroid induced osteonecrosis: An analysis of steroid dosing risk. Autoimmun Rev 9(11):721–743

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, 06500, Ankara, Turkey

    Öykü Öztürk Gündoğdu & Dilek Aynur Cankal

  2. Unit of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Gazi University, 06560, Ankara, Turkey

    Zühre Kaya, Serap Kirkiz & Ülker Koçak

  3. Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Gazi University, 06500, Ankara, Turkey

    Zühre Akarslan

Authors
  1. Öykü Öztürk Gündoğdu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dilek Aynur Cankal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zühre Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zühre Akarslan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Serap Kirkiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ülker Koçak
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Z.K, S.K, and Ü.K. recruited patients. Material preparation, data collection and analysis were performed by Z.K, Ö.Ö.G, Z.A, and D.Ç. The first draft of the manuscript was written by Z.K, D.Ç, and Ö.Ö.G. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Zühre Kaya.

Ethics declarations

Ethics Approval

The study is by recognized standards of ethics as Declaration of Helsinki and approval was granted by the Ethics Committee of the Gazi University Faculty of Dentistry Turkey (Date: 11.03.2022 /No: E.311745). Written informed consent was obtained from all individual participants included in the study.

Conflicts of Interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gündoğdu, Ö.Ö., Cankal, D.A., Kaya, Z. et al. Temporomandibular Joint and Dental Complications in Long-Term Survivors of Children with Leukemia after Chemoradiotherapy and Stem Cell Transplantation. Indian J Hematol Blood Transfus (2024). https://doi.org/10.1007/s12288-024-01786-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12288-024-01786-y

Keywords

Search

Navigation