Dental Care

Brushing your teeth twice a day is always a good idea. It is even more important for childhood cancer patients.

Certain chemotherapy and radiation treatments can cause conditions to develop in the teeth, gums, and mouth.

Risk Factors for Oral Problems

• Chemotherapy in patients before their permanent teeth were fully formed, especially if they were younger than 5
• Chemotherapy for a long period of time
• Radiation therapy to the head/ neck area

Daily care of the teeth, gums, and mouth can prevent certain problems. It may also lessen some painful side effects. Poor dental habits can make problems worse.

Possible conditions may include:

• Increased risk of cavities
• Shortening or thinning of the roots of the teeth or absence of teeth or roots
• Problems with tooth development such as small teeth, early loss of teeth, or baby teeth not falling out
• Problems with development of tooth enamel causing white or discolored patches, grooves and pits, and easy staining
• Facial abnormalities, including overbite, underbite, or facial asymmetry
• Gum disease
• Dry mouth
• Mouth and throat sores (mucositis)
• Difficulty swallowing
• Difficulty chewing or opening the mouth
• Scarring and hardening of the jaw muscles
• Swelling or pain in the lining of the mouth and tongue

Teeth and Gum Care

Proper dental care is important before, during, and after cancer treatment.

• Brush teeth and tongue at least twice each day with a soft-bristled nylon toothbrush. Patients should replace their toothbrush every 2 months.
• Use toothpaste with fluoride and the American Dental Association seal of approval. For children younger than 3, use a smear or rice-size amount of toothpaste. A pea-size amount should be used for children 3-6 years of age.
• Floss daily unless the care team tells you not to. Flossing is usually recommended while patients are on therapy, unless their blood counts are low. Check with your care team if you aren’t sure. Sometimes flossing can cause bleeding and could release germs into the bloodstream that could cause an infection.
• Avoid food that will dry out the mouth and cause cavities, such as sodas, fruit juice and candy.

In addition, your care team may recommend an oral rinse.

Other Oral Health Tips

Drinking water, sucking on ice chips, and using candy sweetened with Xylitol can help manage dry mouth.

If you vomit, rinse out your mouth with water. Brush your teeth, if possible. Acid from the stomach can erode teeth.

Talk with your care team about ways to get enough Vitamin D and calcium to promote good bone health. Do not take supplements unless they are recommended by the care team.

Regular Visits to the Dentist

Patients should visit the dentist regularly before, during, and after the completion of therapy.

Before Treatment

If possible, patients are encouraged to have a dental exam before treatment begins. But a dental exam or procedures may not be possible after cancer therapy has begun.

Braces and other orthodontic devices may need to be removed before treatment to prevent oral complications such as gingivitis, mucositis, and dental decay from occurring inside the mouth.

During Treatment

Families should consult their child’s care team about the timing of dental visits after cancer treatment begins. They should also alert the team if any dental issues occur.

The dentist will work with other care team members. They will make decisions on dental care based on the patient’s current dental health and how cancer treatment may have an impact. For example, the team may delay dental procedures when patients are at increased risk for infection or excessive bleeding.

After Treatment

Patients may develop dental conditions years after therapy is over.

If possible, survivors may want to look for a dentist familiar with the effects of childhood cancer treatment on oral health. The care team at the pediatric center may have recommendations.

Survivors should tell their dentist about their cancer treatment and share a copy of their survivorship care plan.

Consequences of Poor Dental Hygiene

Poor dental hygiene can lead to cavities. A cavity could quickly become a serious infection in a child undergoing therapy. If an infection is not treated, it could spread and become life threatening.

Poor dental care may also lead to gum disease.

Treatments for Oral Problems

If problems occur, there are types of oral care and dental work that can help:

• Permanent teeth that do not develop normally or missing teeth — Patients may need procedures that improve the function of their teeth. These procedures may include permanent crowns, removal of teeth, implants, or possibly a prosthetic device.
• Poor bone growth of the face or jaw — Sometimes reconstructive surgery can help.
• Difficulty moving jaw muscles — The dental team may recommend occupational therapy or stretching exercises.