ÇOCUKLUK ÇAĞI KANSERİ TEDAVİSİ GÖRMÜŞ HASTALARDA ORTODONTİK TEDAVİ YAKLAŞIMLARI : SİSTEMATİK DERLEME

Günümüzde gelişen tedavi yöntemlerinin de etkisiyle pediatrik dönemde kanser tanısı almış hastaların tedavilerinde olumlu sonuçlar elde edilmekte, bununla birlikte sağkalım oranları ve beklenen yaşam süresi artmakta, dolayısıyla bu hastaların yaşam kalitelerinin arttırılması önem kazanmaktadır. İyileşme oranlarındaki artış ile birlikte bu hastaların ortodontik tedavi talepleri de artmaktadır. Bu derlemenin amacı iyileşmiş pediatrik onkoloji hastalarında ortodontik tedavi planlaması ve uygulanmasında dikkat edilmesi gereken hususların incelenmesi ve kliniğe yönelik bir rehber sunulmasıdır. Onkolojik tedavilerde kullanılan kemoterapötik ilaçların büyümeyi baskılayıcı etkisi ile büyüme-gelişim çağındaki çocuklarda dental ve kraniofasiyal yapılarda bir takım değişiklikler meydana gelmektedir. Hastanın tedavi gördüğü döneme bağlı olarak diş yapısında da mine, kök defektleri, şekil anomalilerine rastlanabilmektedir. Bu noktada ortodontik tedavi dental gelişim yetersizlikleri ve büyümedeki farklılıklar düşünülerek tedavi planlanmalı ve yürütülmelidir. Çocukluk çağı kanser hastalarında ortodontik tedavilerde en önemli kriter tedavi zamanlaması olup, tanı almış bir hastada hiçbir koşulda ortodontik tedaviye başlanılmaz, eğer başlanılmış ise tedavi sonlandırılır. Bu hastalarda sadece onkolojik tedavi tamamlandıktan sonra ve belli koşullar altında ortodontik tedavi uygulamaları yapılabilir. Ortodontik tedavi esnasında mukozal irritasyon ve kök rezorpsiyonu gibi yan etkiler görülebileceği akılda tutulmalıdır. Ortodontik tedaviye aktif kanser tedavisinin tamamlanmasından minimum 2 yıl sonra başlanmalı, olası riskleri minimize etmek amacıyla düşük kuvvetlerle çalışılmalı ve gerekli durumlarda tedavinin ideale ulaşmadan bitirilmesi kabul edilmelidir.

Anahtar Kelimeler:

pediatrik onkoloji, dişhekimliği, ortodonti

PDF

___

Dahllöf G, Huggare J. Orthodontic considerations in the pediatric cancer patient: A review. Semin Orthod .2004;10(4):266–76. doi: http://dx.doi.org/10.1053/j. sodo.2004.09.007
Kutluk MT, Yeşilipek MA. Pediatric cancer registry in Turkey (Turkish Pediatric Oncology Group & Turkish Pediatric Hematology Association). J Glob Oncol. 2018;4(Supplement 2):67s–67s. doi: http://dx.doi. org/10.1200/jgo.18.25100
Bleyer WA, The US, Linet MS, Ries LA, Smith MA, Tarone RE, et al. Cancer surveillance series: Recent trends in childhood cancer incidence and mortality in the United States. Review Journal of Clinical and Diagnostic Research. 1997;33(9):1–4.
Linet MS, Ries LA, Smith MA, Tarone RE, Devesa SS. Cancer surveillance series: recent trends in childhood cancer incidence and mortality in the United States. J Natl Cancer Inst [Internet]. 1999;91(12):1051–8. doi: http:// dx.doi.org/10.1093/jnci/91.12.1051
Mishra s. Orthodontic therapy for paediatric cancer survivors: A. Review Journal of Clinical and Diagnostic Research. 2017;11(3):1–4.
Boyer É, Robert G, Gandemer V, Bonnaure-Mallet M. Orthodontic strategies in pediatric oncology. J Dentofac Anom Orthod . 2017;20(1):104. doi: http://dx.doi. org/10.1051/odfen/2016035
Moëll C, Garwicz S, Westgren U, Wiebe T. Disturbed pubertal growth in girls treated for acute lymphoblastic leukemia. Pediatr Hematol Oncol . 1987;4(1):1–5. doi: http://dx.doi.org/10.3109/08880018709141243
Byrne JJ. The effect of ionizing irradiation on the developing maxilla and mandible. Am J Orthod .1961;47(9):646–60. doi: http://dx.doi.org/10.1016/0002- 9416(61)90109-9
Göz G, Wannenmacher M, Dücker J, Jobke A. Die kraniofaziale Entwicklung nach Strahlentherapie im Kindesalter. Fortschritte der Kieferorthopädie.1988;49(1):29–36. doi: http://dx.doi. org/10.1007/bf02163690
Dahllöf G, Forsberg CM, Ringdén O, Bolme P, Borgström B, Näsman M, et al. Facial growth and morphology in long-term survivors after bone marrow transplantation. Eur J Orthod.1989;11(4):332–40. doi: http://dx.doi.org/10.1093/oxfordjournals.ejo.a036004
Sonis AL, Tarbell N, Valachovic RW, Gelber R, Schwenn M, Sallan S. Dentofacial development in long-term survivors of acute lymphoblastic leukemia: A comparison of three treatment modalities. Cancer. 1990;66(12):2645–52.
Gabrielle PA, Bruno CJ, Claudia SM, Luis GS, Addah RF. A review of the biological and clinical aspects of radiation caries. J Contemp Dent Pract. 2009;10:1–11.
Stubberfield TG, Byrne GC, Jones TW. Growth and growth hormone secretion after treatment for acute lymphoblastic leukemia in childhood. 18-Gy versus 24-Gy cranial irradiation. J Pediatr Hematol Oncol. 1995;17(2):167–71.
Arikoski P, Kröger H, Riikonen P, Parviainen M, Voutilainen R, Komulainen J. Disturbance in bone turnover in children with a malignancy at completion of chemotherapy. Med Pediatr Oncol [Internet]. 1999;33(5):455–61. doi: http://dx.doi.org/10.1002/ (sici)1096-911x(199911)33:5<455::aid-mpo4>3.0.co;2-3
Crofton PM. Effects of intensive chemotherapy on bone and collagen turnover and the growth hormone axis in children with acute lymphoblastic leukemia. J Clin Endocrinol Metab [Internet]. 1998;83(9):3121–9. doi: http://dx.doi.org/10.1210/jc.83.9.3121
Brennan BM, Rahim A, Adams JA, Eden OB, Shalet SM. Reduced bone mineral density in young adults following cure of Acute Lympblastic Leukaemia in childhood. British Journal of Cancer. 1999;79(11– 12):1859–63.
Alpaslan G, Alpaslan C, Gögen H, Oguz A, Çetiner S, Karadeniz C. Disturbances in oral and dental structures in patients with pediatric lymphoma after chemotherapya Preliminary report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 1999;87:317–21.
Burden D, Mullally B, Sandler J. Orthodontic treatment of patients with medical disorders. Eur J Orthod 2001;23(4):363–72. doi: http://dx.doi.org/10.1093/ ejo/23.4.363
Köstler WJ, Hejna M, Wenzel C, Zielinski CC. Oral mucositis complicating chemotherapy and/or radiotherapy: options for prevention and treatment. CA Cancer J Clin. 2001;51(5):290–315. doi: http://dx.doi. org/10.3322/canjclin.51.5.290
Avşar A, Elli M, Darka O, Pinarli G. Long-term effects of chemotherapy on caries formation, dental development, and salivary factors in childhood cancer survivors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104(6):781–9.doi: http://dx.doi.org/10.1016/j. tripleo.2007.02.029
Purdell-Lewis DJ, Stalman MS, Leeuw JA, Humphrey GB, Kalsbeek H. Long term results of chemotherapy on the developing dentition: caries risk and developmental aspects. Community Dent Oral Epidemiol. 1988;16(2):68– 71. doi: http://dx.doi.org/10.1111/j.1600-0528.1988. tb01845.x
Hong CH, Fonseca DA. Consideration in the paediatric population with cancer. Dent Clin N Am. 2008;52:155–81.
Malkan UY. Pediatric chemotherapeutic regimen (BFM-95) is superior for overall survival in adult acute lymphoblastic leukemia. Int J Hematol Oncol . 2018;28(4):254–60. doi: http://dx.doi.org/10.4999/ uhod.182852
Sudersanadas K, Clinical Nutrition Department (Female). Effect of chemotherapy on nutritional status of pediatric subjects with hematological malignancies - A retrospective longitudinal study. J Med Sci Clin Res. 2017;05(05):21201–15. doi: http://dx.doi.org/10.18535/ jmscr/v5i5.01
Darzy KH, Shalet SM. Radiation-induced growth hormone deficiency. Horm Res [Internet]. 2003;59 Suppl 1(Suppl. 1):1–11. doi: http://dx.doi. org/10.1159/000067834
Forsberg C-M, Krekmanova L, Dahllöf G. The effect of growth hormone therapy on mandibular and cranial base development in children treated with total body irradiation. Eur J Orthod. 2002;24(3):285–92. doi: http:// dx.doi.org/10.1093/ejo/24.3.285
Sheller B, Williams B. Orthodontic management of patients with hematologic malignancies. Am J Orthod Dentofacial Orthop. 1996;109(6):575–80. doi: http:// dx.doi.org/10.1016/s0889-5406(96)70068-9
Mitus-Kenig M, Derwich M, Czochrowska E, Pawlowska E. Quality of life in orthodontic cancer survivor patients-A prospective case-control study. Int J Environ Res Public Health. 2020;17(16):5824. doi: http:// dx.doi.org/10.3390/ijerph17165824
Reuther T, Schuster T, Mende U, Kübler A. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients-a report of a thirty Year Retrospective Review. International Journal of Oral and Maxillofacial Surgery. 2003;32(3):289–95.
Dahllöf G, Jönsson A, Ulmner M, Huggare J. Orthodontic treatment in long-term survivors after pediatric bone marrow transplantation. Am J Orthod Dentofacial Orthop . 2001;120(5):459–65. doi: http:// dx.doi.org/10.1067/mod.2001.118102
Werkmeister R, Szulczewski D, Walteros-Benz P, Joos U. Rehabilitation with dental implants of oral cancer patients. J Craniomaxillofac Surg. 1999;27(1):38–41. doi: http://dx.doi.org/10.1016/s1010-5182(99)80008-0
Andersson G, Andreasson L, Bjelkengren G. Oral implant rehabilitation in irradiated patients without adjunctive hyperbaric oxygen. Int J Oral Maxillofac Implants. 1998;13(5):647–54.
Visch LL, van Waas MAJ, Schmitz PIM, Levendag PC. A clinical evaluation of implants in irradiated oral cancer patients. J Dent Res.2002;81(12):856–9. doi: http:// dx.doi.org/10.1177/154405910208101212
van Venrooy JR, Proffit WR. Orthodontic care for medically compromised patients: possibilities and limitations. J Am Dent Assoc. 1985;111(2):262–6. doi: http://dx.doi.org/10.14219/jada.archive.1985.0085
Burden D, Mullally B, Sandler J. Orthodontic treatment of patients with medical disorders. Eur J Orthod. 2001;23(4):363–72. doi: http://dx.doi.org/10.1093/ ejo/23.4.363
Levander E, Malmgren O, Eliasson S. Evaluation of root resorption in relation to two orthodontic treatment regimes. A clinical experimental study. Eur J Orthod. 1994;16(3):223–8. doi: http://dx.doi.org/10.1093/ ejo/16.3.223