Abstract | INTRODUCTION: Peripheral neurotoxicity and neuropathic pain are well-known complications of several anti- cancer chemotherapeutic agents. Such pain might cause an impairment of the patient's quality of life and is a common limiting factor of anti- cancer chemotherapy. Neurotoxicity in orofacial structures has been previously described as diffuse jaw pain or numbness. Currently, localized pulpal pain is not listed as a possible complication of cytotoxic therapy. The aim of this report was to suggest cytotoxic-induced neurotoxicity as a differential diagnosis for toothache during anti- cancer therapy. METHODS: We described the diagnostic process in a patient suffering from severe pulpal pain in apparently intact teeth during cytotoxic therapy. A non-Hodgkin's lymphoma patient complained of 2 episodes of excruciating dental pain evoked by mouth breathing, which caused nocturnal awakenings. RESULTS: Both episodes developed immediately after administrations of cyclophosphamide as part of an anti- cancer chemotherapy protocol. Clinical parameters and radiographic characteristics eliminated other possible dental and facial etiologies. Pulp extirpation ( pulpectomy) resulted in immediate pain relief. In both episodes, cytologic evaluation of the extirpated pulp tissue failed to show inflammation or an infiltration of lymphoma cells. CONCLUSIONS: This case presented a circumstantial relation between the clinical presentation of dental pain, with associated significant impairment of the patient's quality of life, and the timing of administrations of high-dose cyclophosphamide. It suggests that chemotherapy-induced toxicity might manifest as pulpitis-like toothache, which might present a diagnostic challenge for the dental practitioner.
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Authors | Yehuda Zadik, Vladimir Vainstein, Ilana Heling, Tzahi Neuman, Scott Drucker, Sharon Elad |
Journal | Journal of endodontics
(J Endod)
Vol. 36
Issue 9
Pg. 1588-92
(Sep 2010)
ISSN: 1878-3554 [Electronic] United States |
PMID | 20728733
(Publication Type: Case Reports, Journal Article)
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Copyright | Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Antineoplastic Agents, Alkylating
- Cyclophosphamide
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Topics |
- Antineoplastic Agents, Alkylating
(adverse effects, therapeutic use)
- Cyclophosphamide
(adverse effects, therapeutic use)
- Dental Pulp
(drug effects)
- Diagnosis, Differential
- Humans
- Lymphoma, Non-Hodgkin
(complications, drug therapy)
- Male
- Middle Aged
- Neurotoxicity Syndromes
(diagnosis, etiology)
- Toothache
(chemically induced, diagnosis)
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