Developmental defects of enamel in childhood cancer survivors: A systematic review and meta-analysis

Authors:

ABSTRACT

Aim

The present systematic review and meta-analysis (Prospero registration number: CRD42023472016) aims to assess the prevalence of developmental defects of enamel (DDEs), qualitatively and/or quantitatively, in childhood cancer survivors (CCS) and evaluate, when possible, these data in comparison with those found in healthy children.

Methods

Three electronic databases (PubMed, Embase, Scopus) were searched from January 2003 to January 2024 for studies reporting on DDEs in children with a mean age not exceeding 16 years at the time of the study who underwent antineoplastic therapy. The ROBINS-I and the Joanna Briggs Institute (JBI) tools were used to assess the risk of bias. Included studies with comparable outcomes underwent random effects models meta-analysis using Stata®18.

Results

Overall, 807 records were retrieved, 74 studies were selected based on title and abstract, 21 full texts were included in qualitative synthesis, and 18 were included in the meta-analysis. The prevalence of DDEs in CCS varied widely, ranging from 13.16% to 88.30%. The prevalence of qualitative defects ranged from 56.60% to 67.00%, while quantitative defects ranged from 3.10% to 58.20%. From the meta-analyses, the pooled prevalences of CCS with DDEs were as follows: overall DDEs at 0.42 [95% CI: 0.25-0.58], qualitative defects at 0.63 [95% CI: 0.57-0.68], and quantitative defects at 0.23 [95% CI: 0.13-0.34]. Additionally, the log odds ratios for developing DDEs in CCS compared to healthy children were 1.59 [95% CI: 0.7 5-2.42] for overall DDEs, 1.63 [95% CI: 1.09-2.17] for qualitative defects, and 0.72 [95% CI: 0.28-1.17] for quantitative defects. The overall log odds ratio of developing qualitative over quantitative enamel defects in CCS was 1.64 [95% CI: 0.21-3.07], I2 =92.80%.

Conclusion

CCS showed a higher prevalence of DDEs, both qualitative and quantitative, compared to healthy children. The meta- analysis showed higher odds of developing qualitative defects over quantitative defects in CCS. Conclusions regarding the association between the type of therapy administered, age of therapy initiation, and prevalence of DDEs could not be drawn due to insufficient data. A lack of a standardized method of detecting enamel defects posed a challenge in the qualitative and quantitative analysis.

PLUMX METRICS