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4 808三 穂 蓉 子 ほ か:小 児 白血1病に認 め ら れ た歯 の形 成 障 害 図3-112歳0か 月,ALL,男 真 3歳4か 児 のパ ノ ラマエ ックス線写 図3-313歳0か ll}}ll u 型搬 臨 彬 月,ALL,女 真 4歳5か 月か ら化 学 療 法 を開 始 した 6歳10か 舗 児 の パ ノ ラ マ エ ッ クス 線 写 月 か ら化 学 療 法 を 開 始,6歳4か?1}}1? U 根繍,窺 図3-26歳11か 月,ALL,女 児 のパ ノラマ エ ックス線写 真 0歳9か 月 か ら 化 学 療 法 を 開 始,0歳11か に移 植 療 法 を受 け た ll錫 鋒 器 揚ll か 月 と6歳10か 倭噛{需 聴 根蹴 瑠 辮 Y型歯 u1型歯根聯 月,AML,男 真 10歳1か 児 の パ ノ ラマ エ ッ クス 線 写 月 か ら 化 学 療 法 を 開 始,11歳1か 月 に移 植 療 法 を受 け た 窺 歯の蜘 粥 瑠 u 型搬 繍 v 型歯根短 茜 月 に移 植 療 法 を受 け た症 例 の13歳0か 月 時 の パ ノ ラマ エ ック ス線 写 真 で あ る 前 歯 部 か ら臼歯 明 で あ り,今 2)化 回 は 検 討 しな か っ た 学 療 法 に よ る 歯 の 形 成 障 害 と発 育 段 階 と の 関 連 を,図4,表3に 部 にか け て歯 根 短 縮 が認 め られ た 図3-4は,10歳1か 図3-416歳1か 月 月 と 月 に移 植 療 法 を受 け た 月 か ら化 学 療 法 を 開 始 し,11歳 1か 月 に 移 植 療 法 を受 け た 症 例 の16歳1か 月時 のパ ノ 示 す 歯 の 欠如 は どの 段 階 にお い て も 1例 も認 め ら れ な か っ た 発 育 段 階0で (95.5%)に 簸 小 歯 が 認 め ら れ,1歯 ラマ エ ッ クス線 写 真 で あ る 小 臼歯 お よ び第 二 大 臼歯 に な か っ た 発 育 段 階5か U2型 歯 根 短 縮 が 認 め られ た 縮 が 認 め ら れ た 特 に 段 階6で 2-各 群 の歯 の形 成 障 害 と発 育 段 階 との 関連 %),段 1)歯 の形 成 障害 は治 療 開始 後 約4年 経 過 す る とエ ック か しU1,Vl,V2型 階7で14歯 ス線 写真 上 で観 察 され る こ とが 分 か っ た ま た乳 歯 の 根 3)頭 形 成 障 害 は認 め られ たが,生 理 的 歯 根 吸 収 との 関 係 が 不 と の 関 連 は,認 ら7に は22歯 に は影 響 が認 め られ か け て はU2型 中9歯(64-3%)に 中21歯 は15歯 歯根 短 中12歯(80.0 認 め られ た し 歯 根 短 縮 は認 め られ なか った 蓋 放 射 線 照 射 療 法 に よ る 歯 の 形 成 障 害 と発 育 段 階 め ら れ な か っ た す な わ ち,移 植 を受 け

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7 1 ) Moorrees, C. F. A., Fanning, E. A. and Hunt, E. E. Jr.: Age variation of formation stages for ten permanent teeth, J. Dent. Res., 42: , ) Maguire, A. and Welbury, R. R.: Long-term effects of antineoplastic chemotherapy and radiotherapy on dental development, Dental Update, 23: , ) Dahlia, G., Rozell, B., Forsberg, C. and BorgstrOm, B.: Histologic changes in dental morphology induced by high dose chemotherapy and total body irradiation, Oral Surg. Oral Med. Oral Pathol., 77: 56-60, ) Hunn, J. H., Welbury, R. R., Gordon, P. H., Kernahan, J. and Craft, A. W.: Dental caries and dental anomalies in children treated by chemotherapy for malignant disease, Int. J. Paediatric Dentistry, 1: , ) Purdell-Lewis, D. J., Stalman, M. S., Leeuw, J. A., Humphrey, G. B. and Kalsbeek, H.: Long term results of chemotherapy on the developing dentition: caries risk and developmental aspects, Community Dent. Oral Epidemiol., 16: 68-71, ) Rosenberg, S. W., Kolodney, H., Wong, G. Y. and Murphy, M. L.: Altered dental root development in long-term survivors of pediatric acute lymphoblastic leukemia, Cancer, 59: , ) Sonis, A. L., Tarbell, N., Valachovic, R. W., Gelber, R., Schwenn, M. and Sallan, S.: Dentofacial development in long-term survivors of acute lymphoblastic leukemia, Cancer, 66: , ) DahllOf, G., Barr, M., Bolme, P., Modeer, T., LOnnqvist, B., Ringden, 0., et al.: Disturbances in dental development after total body irradiation in bone marrow transplant recipients, Oral Surg. Oral Med. Oral Pathol., 65: 41-44, ) Nasman, M., Forsberg, C. and DahllOf, G.: Long-term dental development in children after treatment for malignant disease, Euro. J. Orthodontics, 19: , ) Uderzo, C., Franschini, D., Balduzzi, A., Galimberti, S., Arrigo, C., Biagi, E. and Pignanelli, M.: Long-term effects of bone marrow transplantation on dental status in children with leukemia, Bone Marrow Transplant., 20: , ) DahllOf, G., JOnsson, A., Ulmner, M. and Huggare, J.: Orthodontic treatment in long-term survivors after pediatric bone marrow transplantation, Am. J. Orthod. Dentofacial Orthop., 120: , 2001.

8 Dental Developmental Disturbances in Children after Treatment for Leukemia and Formation of Yoko Miho, Masakazu Ikeda, Yoshinori Inoue* and Toshio Yamaguchi Department of Dentistry, Kanagawa Children's Medical Center (Director: Dr. Masakazu Ikeda) *Department of Maxillofacial Growth and Development, Kanagawa Dental College (Director: Prof. Sadao Sato) Treatment for pediatric leukemia may have adverse effects on developing teeth. We studied the dental development, using panoramic radiographs, of 31 patients younger than age 12 diagnosed as having leukemia, and investigated the relationship between the permanent tooth formation stages and treatment for leukemia. The disturbances in tooth development were classified into three major groups such as agenesis, microdontia and arrested root development. Further, arrested root development was classified into five varieties according to root morphology and shortening degree. 1. As for the relationship between the dental developmental disturbances by chemotherapy and the tooth formation, stage, microdontia was observed among 95.5% of the cases in the stage of "before the start of calcification." In addition, U 2-type arrested root development was observed in approximately 80% in the stage of "crown complete." 2. As for the relationship between the dental developmental disturbances by hematopoietic stem cell transplantation and the tooth formation stage, in the stage of "before the start of calcification," agenesis was observed in 83.3% of the cases, and microdontia was observed in 16.7% of the cases. Microdontia was observed in 90% or more of the cases in the stage of "cusp formation." As for arrested root development, it was observed in 100% of the cases in some root morphology from the stage of "crown 3/4 complete" to "root length 1/2." V 1-type arrested root development was observed in 76.5% of the cases in the stage of "crown 3/4 complete" ; V 2-type arrested root development was observed in 45.9% of the cases in the stage of "crown complete" ; Y-type arrested root development was observed in 31.3% of the cases in the stage of "root length 1/4" ; U 1-type arrested root development was observed in 33.3% of the cases in the stage of "crown complete" ; U 2-type arrested root development was observed in 68.2% of the cases in the stage of "root length 3/4." 3. Dental developmental disturbances were observed by radiographs at four years after the treatment. Key words: Pediatric leukemia, Dental developmental disturbances, Chemotherapy, Hematopoietic stem cell transplantation

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