Dentale: a validated Dentofacial EvaluatioN Tool to standardize radiological Assessment of Late dental and maxillofacial adverse Effects following treatment for pediatric rhabdomyosarcoma

Abstract

OBJECTIVES: The treatment of childhood cancers causes significant late dental adverse effects, which are evident on radiographic imaging and potentially affect future function. Currently, no standardized tool exists for objectively assessing these effects. This study aimed to develop and validate a new radiographic evaluation tool, "DENTALE," to guide dental care for survivors and aid research on late dental effects. METHODS: This cross-sectional validation study employed a systematic tool development approach, following established guidelines. The tool was developed through orthopantomogram (OPG) assessment by three dentists using 10 cases of head and neck rhabdomyosarcoma survivors with a wide range of dental abnormalities. Development validation was conducted through the evaluation of 14 OPGs by three independent dentists. Interobserver reliability was assessed using intraclass correlation coefficients (ICCs). Content validity was established through expert consensus, and clinical utility was evaluated using sensitivity and specificity analyses for referral decision-making. This was later validated in a larger cohort (n = 83) and subsequently adapted. RESULTS: The key anatomical features evaluated by the tool are as follows: the morphological condylar process, mandibular ascending ramus, alveolar process, tooth presence, and tooth morphology. Interobserver reliability demonstrated good to excellent agreement (ICC: 0.857-0.939, 95% CI: 0.66-0.98). Using a threshold score of 16 points, the tool achieved 100% sensitivity and 90.0% specificity for specialized dental care referral decisions, with positive and negative predictive values of 94.6% and 100%, respectively. CONCLUSIONS: DENTALE offers a validated and practical radiographic scoring system for OPGs, enabling both clinicians and researchers to assess objectively late dental adverse effects following childhood cancer treatments. CLINICAL SIGNIFICANCE: This tool supports evidence-based referral to specialized dental healthcare, thereby supporting patient management. Furthermore, by standardizing methodology and reporting research on dental late effects, DENTALE can facilitate comparisons across treatments and treatment modalities.