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Dental Late Effects

Some childhood cancer treatments can cause problems with teeth and facial bone development later in life.

Cancers Treatments That Can Cause Dental Problems

These treatments include:

  • Chemotherapy before the permanent teeth were fully formed, especially if the child was younger than 5 at the time of treatment. Problems are also more likely to occur if the patient has had chemotherapy over a long period of time (several years.)
  • Azathioprine, sometimes given to patients as part of a hematopoietic cell transplant (also known as bone marrow or stem cell transplant)
  • Radiation to the mouth or salivary glands.
  • Total body irradiation (TBI) as part of a transplant.

Other risk factors

  • Chronic graft versus host disease can lead to dental problems.

Survivors younger than 5 years old at the time of treatment are often at a higher risk because their permanent teeth have not fully formed.

A graphic of two teeth. The tooth on the left shows the tooth's exterior, with labels for the crown, neck, and root. The tooth on the right shows the tooth's interior, with labels for the enamel, dentin, pulp cavity, gums, root canal, bone, cement, and nerves and blood vessels.

Dental Problems That May Occur

For survivors who have had chemotherapy or a transplant

Possible dental problems include:

  • Increased risk for cavities.
  • Shortening or thinning of tooth roots.
  • Absence of teeth or roots.
  • Problems with tooth enamel development that result in white or discolored patches, grooves, and pits. Teeth may easily stain.

Radiation-related problems include:

  • Increased risk of cavities
  • Shortening or thinning of tooth roots
  • Absence of teeth or roots
  • Abnormal tooth enamel development resulting in:
    • White or discolored patches on the teeth
    • Grooves and pits in the teeth
    • Easy staining of teeth
  • Small teeth
  • Early tooth loss
  • Baby teeth not falling out
  • Problems with tooth development or delayed eruption of permanent teeth
  • Increased tooth sensitivity to hot and cold sensations
  • Dry mouth because of decreased production of saliva (xerostomia)
  • Changes in taste
  • Limited ability to fully open the mouth (trismus)
  • Joint problems (temporomandibular joint dysfunction) that can cause pain in the area in front of the ears
  • Bite problems (overbite or underbite)
  • Abnormal growth of bones in the face and neck
  • Gum (periodontal) disease
  • Trouble with jawbone healing (osteoradionecrosis) after dental procedures such as oral surgery or having teeth pulled
  • Increased risk for cavities
  • Missing teeth
  • Teeth with white or discolored patches, grooves or pits due to improperly developed tooth enamel

Oral Cancer

Some childhood cancer survivors may also be at risk for oral cancer. These include patients who:

  • Had radiation to the head and neck.
  • Have chronic graft-versus-host disease.
  • Use alcohol and tobacco.
  • Human papillomavirus (HPV) infection

Signs and symptoms of oral cancer include:

  • A sore that does not heal
  • A sore that bleeds easily
  • A marked change in the color of mouth tissues
  • A lump or rough spot in the mouth
  • Pain, tenderness, or numbness in the mouth or on the lips

If any of these signs and symptoms occur, contact a local dentist for a consultation.

What Survivors Can Do

  1. It is especially important for childhood cancer survivors to take excellent care their teeth and gums.

    • Brush teeth at least twice a day with fluoride toothpaste
    • Gently floss teeth daily
    • Use a fluoride mouth rinse daily, preferably antibacterial and alcohol-free
    • Drink liquids often, using artificial saliva, or both
    • Limit foods high in carbohydrates and sugar (sweets)
    • Drink alcohol in moderation and do not use tobacco products at all as both increase the risk of cancer. Any form of tobacco use greatly increases the risk for oral cancer

    Poor dental habits can lead to cavities, gum disease, and infection in the bones that support tooth roots.

    Patients who received radiation therapy to the mouth may need to visit an orthodontist, who can help address teeth alignment or skull or facial problems.

  2. Regular dental care is particularly important for survivors of childhood cancer. It should include:

    • A dental check-up with cleaning and fluoride every six months. The check-up will include an exam to check dental health, signs of disease, or anything unusual. The dentist will also take a history of the patient’s health, habits, and treatments.
    • Imaging, including a panoramic (“panorex”) X-ray. It will include detailed pictures of teeth, roots and jaws to look at root development and the strength of the supporting bone.
  3. Survivors with the certain health conditions should also ask their dentist about taking special precautions, including antibiotics, to avoid infection when having dental work done. Conditions include:

    • Shunt (a tube that drains fluid from the brain)
    • Limb salvage procedure: metal rod or bone graft to replace bone
    • Leaky or scarred heart valve (this can happen after radiation to the chest)
    • Surgical removal of spleen (splenectomy)
    • High doses of radiation to the spleen
    • Currently active chronic graft-versus-host disease (cGVHD) after a hematopoietic cell transplant (also called a bone marrow or stem cell transplant)

    Other conditions survivors should inform their dentist about include:

    • High doses of radiation to the face or mouth, as dental surgery may increase the risk of developing osteoradionecrosis (a bone-healing problem). The dentist should talk to a radiation oncologist before any dental surgery.
    • An allogeneic hematopoietic cell transplant (also known as bone marrow transplant or stem cell transplant,) so the dentist can check for changes that could indicate chronic graft-versus-host disease.
  4. Survivors can be treated for dental problems:

    Permanent teeth that do not develop normally
    Caps or crowns
    Poor bone growth in the face or jaw
    Reconstructive surgery
    Difficulty opening the mouth (trismus) or scarring and hardening of jaw muscles (fibrosis)
    Stretching exercises
    Malformed or small teeth
    Bonding (a thin coating of plastic material on the front surface of the teeth)
    Dry mouth (xerostomia). (Related problems may include persistent sore throat, burning sensation in mouth and gums, problems speaking, difficulty swallowing, hoarseness, or dry nasal passages.)
    • Drinking liquids frequently
    • Use of artificial saliva
    • Sugar-free candy
    • Proper brushing habits
    • Daily fluoride (if recommended by dentist)

Reviewed: June 2018