Chemotherapy not sparing the teeth too

Chemotherapeutic agents play a role in treating various blood cancers; there has been an increase in adverse events related to chemotherapy. Skin, nails, and mucous membranes such as oral and genital mucosa pigmentation occur after using chemotherapeutic drugs. In previous article, it is found that 2.8% of patient develops color changes in teeth after using chemotherapy. Chemotherapeutic agents that cause pigmentation are cytarabine, carboplatin, cyclophosphamide, capecitabine, fluorouracil, gemcitabine, etc. Children who undergo chemotherapy before the age of 5 may experience significant damage to their teeth. Chemotherapy can lead to specific dental abnormalities such as microdontia, increased size of the dental pulp chamber, delays in tooth development, or malformations of the roots. The severity of these issues is influenced by the type of chemotherapy drug used and its half-life, as well as the number of cells affected during the cell cycle and the patient’s age when treatment begins. Enamel hypoplasia and discoloration are the most frequently observed defects. Hypoplasia results from damage to ameloblasts that affect their reproductive and secretory functions, as well as their membrane permeability and calcium exchange. Repeated exposure to high doses of cytotoxic medications can lead to root agenesis. A 9-year-old boy diagnosed with B-acute lymphoblastic leukemia developed discoloration of nails and teeth after receiving combination chemotherapy including daunorubicin [Figures 1 and 2]. He developed brownish discoloration of teeth initially appearing in incisor teeth then progress to all teeth. He also developed pigmentary changes over nail plate along with transverse lines across the nail plate, but lunula maintaining normal hue.

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Figure 1:

Color changes of teeth of the patient received chemotherapy.

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Figure 2:

Nail changes of the same patient.

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