Radiological Late Dental Adverse Effects Following Treatment for Paediatric Head and Neck Rhabdomyosarcoma: Results...

Rhabdomyosarcoma represents the most common paediatric soft tissue sarcoma, with 40% occurring in the head and neck region. Given that survival rates now reach 80%, minimising late adverse effects, particularly dental developmental complications, has become a priority. The aim of this paper was to identify the scope, severity and range of such late dental effects following treatment for head and neck sarcoma.

We systematically investigated late dental adverse events using orthopantomograms in rhabdomyosarcoma survivors treated between 1990 and 2014. Orthopantomograms were evaluated using a validated scoring system (DENTALE) that evaluates skeletal deformations, tooth presence, tooth wear, crown shape, eruption, root-crown ratio and root shape.

Among 103 survivors (median age at diagnosis 5.4 years, 42.7% female), 92.2% exhibited dental adverse effects. Missing molars occurred in 45.6% of survivors. Root abnormalities were present in 72.8% of survivors, crown-to-root ratio abnormalities in 56.3% and eruption disturbances in 45.6%. Age at diagnosis was inversely correlated with total adverse effect score (r_s  = -0.389, p < 0.001). Survivors diagnosed before age 6 had significantly higher total dental adverse effect scores (p = 0.008), showing more effects of crowns (p = 0.016), crown-root ratio (p = 0.020), tooth eruption (p = 0.005) and roots (p = 0.006).

This study demonstrates that rhabdomyosarcoma survivors are at substantial risk for a variety of dental developmental issues when treated at a younger age. Consequently, routine dental screening during follow-up is essential, with specialised dental and orthodontic care provided when clinically indicated.