Dental Health After Pediatric Cancer Therapy

What is the risk?

Dental health is the health of your teeth and the roots of your permanent teeth. Some treatments for childhood cancer can affect dental health, like:

• Some chemotherapies.
• Radiation to any part of your head, neck, face, brain, or total body irradiation (TBI).
• Chronic GVHD (graft versus host disease).
• Azathioprine (sometimes given during stem cell transplant).

Dental problems can happen at any time, from weeks to years after treatment. Some dental problems may be:

• A higher risk of cavities.
• Missing teeth or roots.
• Short or thin roots.
• If treatment happened before your permanent teeth came in, these teeth may not develop or come in.
• Problems with enamel, like changes in color, easy staining, or grooves in the teeth.
• Small teeth.
• Gum disease (periodontal disease).
• Taste changes.
• Problems with your jaw.
• A change in color to the inside of your mouth.

Radiation can cause loss of saliva (dry mouth or xerostomia) if it included the salivary glands (found in the bottom and back of the mouth). Saliva helps prevent cavities and tooth decay and helps with speech and swallowing. Loss of saliva can lead to cavities, more rapid tooth decay, and loss of permanent teeth.

In some cases, radiation to the jaw puts you at risk for osteoradionecrosis of the jawbone. The jawbone is unable to heal after things like a dental procedure (such as pulling a tooth). Signs of osteoradionecrosis are jaw pain or being unable to open your jaw. Be sure your dentist knows if you received radiation to the jaw.

Symptoms/ When to Call

• Let your dentist know if you have any of the issues listed above, or:
  • Pain in your mouth, gums, or teeth.
  • A permanent tooth falls out.
  • Any sign of infection like redness, swelling, or gums bleeding more than normal.
  • If you have a lump, rough patch, or sore in your mouth or lip that does not heal.
  • Other dental problems.
• Survivors should let their dentists know about their cancer history and treatment.

Prevention and Treatment

• Dental visits, including cleanings every 6 months, oral exams every year, and a baseline panoramic x-ray, are important to detect problems early.
• You should practice good oral hygiene at home. This includes rinsing your mouth with mouthwash or water and brushing after each meal and flossing every day.
• Stay away from sweet or sugary food, candies, and drinks, as well as carbohydrates, as these can raise the risk of cavities.
• Do not use tobacco products.
• Do not drink alcohol.
• If you had radiation to the mouth area, you will be given instructions on mouth care. This may include regular fluoride treatments. If you have dry mouth, learn more about managing it.
• If you need a dental procedure or braces (orthodontic care), you should have an x-ray to see the roots of your teeth beforehand.
• Use antibacterial, alcohol-free fluoride mouth rinses.
• For survivors who received high doses of radiation in the mouth area (such as for treatment of cancers in the head and neck), hyperbaric oxygen treatment may be recommended before or after dental procedures. Hyperbaric oxygen can help improve wound healing.

How can I learn more about my risk?

• Going to a cancer survivorship clinic can be helpful to learn about your risk and ways to lower your risk. Find a clinic on our list or call local cancer centers to see if they have a clinic for childhood cancer survivors.
• Visit the Children’s Oncology Group website to learn more about risks and recommendations.
• Talk with your care team about your plan for follow-up care.