Dental Health After Pediatric Cancer Therapy

Author: OncoLink Team
Content Contributor: Dava Szalda, MD
Last Reviewed:

What is the risk?

Dental health is the health of your teeth and the roots of your permanent teeth. Both chemotherapy and radiation may affect dental health over time. People who have chronic GVHD (graft versus host disease) or received the medicine azathioprine, which is sometimes given during stem cell transplant, are also at risk of dental issues.

Dental problems can occur at any time, from weeks to years after treatment. They can include:

  • An increased risk of cavities.
  • Missing teeth or roots or short/thin roots.
  • If treatment happened before your permanent teeth came in, these teeth may not develop or come in.
  • Problems with enamel such as discoloration or grooves in the teeth.
  • Small teeth.
  • Gum disease (periodontal disease).

Radiation can cause loss of saliva (dry mouth or xerostomia) if the area radiated includes the salivary glands (located in the bottom and back of the mouth). Saliva plays a very important role in preventing cavities and tooth decay, and in speech and swallowing. Loss of saliva can result in cavities, more rapid tooth decay, and loss of permanent teeth.

Rarely, patients who received radiation to the jaw are at risk for osteoradionecrosis of the jawbone. This complication is an inability of bone to heal after minor trauma such as a dental procedure (such as pulling a tooth). Symptoms of osteoradionecrosis include jaw pain or an inability to open the jaw. Be sure your dentist knows if you received radiation to the jaw.

Symptoms/ When to Call

  • Notify your dentist if you develop:
    • Pain in your mouth, gums, or tooth pain.
    • A permanent tooth falls out.
    • Any sign of infection such as redness, swelling, or gums bleeding more than normal.
    • If you develop a lump, rough patch or sore in your mouth or lip that does not heal.
    • Other dental concerns.
  • Survivors should let their dentists know about their cancer history and treatment.

Prevention and Treatment

  • Dental visits, including cleanings every 6 months, oral exams annually, 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.
  • Avoid or limit sweet or sugary food, candies, and drinks as these can increase the risk of cavities.
  • Do not use tobacco products and limit alcohol use as both can worsen mouth problems.
  • If you received radiation to the mouth area, you will be given further instructions on mouth care which may include regular fluoride treatments. If you have dry mouth, learn more about managing this side effect.
  • If you need a dental procedure or braces (orthodontic care), you should have an x-ray to evaluate the roots of your teeth before any procedures.
  • 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 own risk and ways to reduce 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.
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