Dental Health After Pediatric Cancer Therapy

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

What is the risk?

You may be at a higher risk of dental problems if you had:

• Certain chemotherapy medicines.
• 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 and tooth decay.
• Missing teeth or roots.
• Short or thin roots.
• Loss of permanent teeth. 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.
• Loss of saliva (dry mouth or xerostomia).
• Osteoradionecrosis of the jawbone. This means 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 had radiation to the jaw.

When to Call Your Dentist

It is important to let your dentist know about your cancer history and treatment.

• 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.

Prevention and Treatment

There are things you can do to help your dental health, like:

• Dental visits, including cleanings every 6 months, oral exams every year, and a baseline panoramic x-ray, so problems can be detected early.
• You should practice good oral hygiene at home. This includes rinsing your mouth with mouthwash or water, brushing your teeth after each meal, and flossing every day.
• Try not to eat 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, your care team will tell you how to care for your mouth.  This may include regular fluoride treatments.
• 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 got 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?

• Going to a cancer survivorship clinic can be helpful to learn more about your risk and ways to lower it. 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.