Some childhood cancer treatments can increase the risk of dental problems. Dental problems may appear months or years after treatment. You can help prevent problems by taking care of your teeth, gums, and mouth every day. Regular dentist visits can help find problems early when they are easier to treat.
Risk factors for dental problems
Regular dental check-ups every 6 months and regular imaging of the teeth, roots, and jaw will help to screen for dental problems.
Cancer treatments and conditions linked to dental problems include:
Chemotherapy before the permanent teeth were fully formed, especially if the child was younger than age 5 at the time of treatment
Radiation to the head or neck
Immunosuppressive medicines used as part of a bone marrow or stem cell transplant
Chemotherapy can affect tooth and gum health, especially when treatment happens at an early age and over a long period of time. Possible dental problems after chemotherapy or a stem cell transplant may include:
Higher risk for cavities (tooth decay)
Short, thin, or missing tooth roots, which can make teeth less stable
Missing or small teeth
Tooth enamel problems, such as white or discolored patches, grooves, pits, and staining
Delayed or abnormal tooth development
Gum disease
Dental problems after radiationt therapy
Radiation to the head and neck can affect the teeth, gums, jaw, and salivary glands. The risk of problems is higher if treatment happened at a young age while teeth were still developing.
Possible dental and oral health problems after radiation to the head or neck may include:
Higher risk of cavities (tooth decay)
Short, thin, or missing tooth roots, which can make teeth less stable
Missing or small teeth
Tooth enamel problems, such as white or discolored patches, grooves, pits, and staining
Delayed or abnormal tooth development
Gum disease
Early tooth loss
Baby teeth not falling out
Sensitivity to hot or cold
Less saliva (spit), which can cause dry mouth
Changes in taste
Jaw pain and stiffness
Problems opening the mouth fully (trismus)
Joint problems (temporomandibular joint dysfunction or TMJ) that can cause pain in front of the ears
Bite problems, such as an overbite or underbite
Abnormal growth of bones in the face or neck
Slow or poor jawbone healing (osteoradionecrosis) after dental work like oral surgery or having teeth pulled
Treatments for dental problems in cancer survivors
Cancer patients and survivors can be treated for many dental and oral health problems. Common dental problems and treatments include:
Dental Problem
Treatment
Permanent teeth that do not grow normally
Caps, crowns, tooth removal, dental implants, or other prosthetic devices
Bonding (a thin coating of plastic material placed on the front of the teeth)
Dry mouth
Drinking liquids; using artificial saliva, sugar-free candy or gum, or mouth rinses; practicing good mouth and dental care
Talk to your dentist or orthodontist about any dental problems. They can recommend specific treatments.
Know your risk of dental problems
Cancer survivors can develop tooth problems, including changes in tooth appearance, enamel strength, and tooth roots.
Know your risk of dental problems. Ask your care team if you have had treatments that could affect your teeth and gums.
Tell your dentist about all cancer treatments you have had, even if they were many years ago.
Share a copy of your Survivorship Care Plan with all health care providers. The plan has details about your cancer treatment and information about health problems that may happen.
If possible, look for a dentist who is familiar with the effects of cancer treatment on oral health. Your care team may have recommendations.
Patients who had radiation therapy to the mouth may need to visit an orthodontist, who can help with teeth alignment or skull or facial problems.
Tell your dentist about treatments that could slow healing or increase infection risk.
Bacteria can enter the bloodstream during dental work and lead to serious infection. You may need to take antibiotics before dental work if you have had certain procedures or conditions.
Other conditions that you should tell your dentist about include:
High doses of radiation to the face or mouth: Dental surgery may increase the risk of developing osteoradionecrosis, which can affect bone healing. Your dentist should talk to a doctor who is trained to treat cancer with radiation (called a radiation oncologist) before any dental surgery or tooth removal.
Get regular dental check-ups
Regular dental care is important for survivors of childhood cancer. Dental care should include:
Dental check-ups every 6 months with cleaning and fluoride treatment. Some people may need more frequent visits, especially if they have enamel problems or dry mouth.
Dental exam and health review. The check-up should include checking your teeth and gums for problems. Talk to your dentist about your oral care habits and medical history, including cancer treatments.
Dental x-rays and imaging, including a panoramic (“panorex”) x-ray. A panoramic x‑ray shows the roots, jawbone, and tooth development.
Dental cleanings after chemotherapy
Most cancer patients can safely have routine dental cleanings once their blood counts return to normal levels. Talk with your care team about when dental cleanings are safe to have. Regular dental care helps prevent cavities and gum disease.
Take care of your teeth and gums
It is important for you to take good care of your teeth and gums. Poor dental habits can lead to cavities, gum disease, and infection in the bones that support tooth roots.
Brush teeth at least 2 times a day with fluoride toothpaste for 2 minutes. Ask your dentist if you need prescription-strength fluoride.
Use a soft bristle toothbrush, as recommended by your dentist.
Place your brush at a slight angle toward the gum when brushing along the gum line.
Clean all surfaces of your teeth.
Brush your tongue to remove bacteria.
Gently floss teeth daily.
Use mouth rinses recommended by your care team.
For dry mouth, drink water often, use a baking soda rinse (1/2 teaspoon of baking soda in 1 cup of warm water), or use artificial saliva (a saliva substitute that you can get over the counter or by prescription).
Chew sugar-free gum with xylitol if approved by your dentist.
Limit foods and drinks high in carbohydrates and sugars.
Do not use tobacco, and limit alcohol intake.
Key points about dental problems after cancer
Some cancer treatments, including chemotherapy and radiation to the head or neck, can affect dental health later.
Common problems include weak enamel, tooth decay, gum disease, missing or small teeth, dry mouth, bite problems, and jaw pain.
Daily oral care, including brushing teeth and flossing gently, can help lower the risk of dental problems.
Get regular dental exams and cleanings. Let your dentist know about past cancer treatments.
