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Dental Problems in Childhood Cancer Survivors

Some childhood cancer treatments can increase the risk for dental problems.

Regular dental visits and taking care of your teeth, gums, and mouth can help prevent dental health problems and detect conditions early when they may be more treatable.

Cancer treatments that can cause dental problems

Cancer treatments that can cause dental problems include:

  • Chemotherapy before the permanent teeth were fully formed, especially if the child was younger than 5 at the time of treatment.
  • 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

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

Top graphic of a healthy tooth showing the root, neck and crown. Bottom graphic shows the bone, root canal, pulp cavity, enamel, nerve and blood vessels and gums.
Several graphics showing tooth problems. The graphic on top left is of a retained baby tooth. The graphic on top right is showing enamel defects on a tooth. The graphic on bottom left is of a cavity. Graphic on bottom right is showing a shortened root.

Dental problems that may occur

  1. For survivors who have had chemotherapy or a transplant

    Possible dental problems that may occur from chemotherapy or a transplant 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.
    • Small teeth
    • Problems with tooth development or eruption of permanent teeth
    • Gum disease

    These problems are more likely to develop in people who received chemotherapy over several years during childhood.

  2. For survivors who have had radiation

    • 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 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 disease
    • Trouble with jawbone healing (osteoradionecrosis) after dental procedures such as oral surgery or having teeth pulled
    • Missing teeth
    • Teeth with white or discolored patches, grooves or pits due to improperly developed tooth enamel

  3. Oral cancer

    Some childhood cancer survivors may 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
    • Have human papillomavirus (HPV) infection

    Signs and symptoms of oral cancer include:

    • A sore that does not heal or bleeds easily
    • A change in the color of mouth tissues
    • A lump, thickening, 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.

Treatments for dental problems

Survivors can be treated for dental problems:

Problem Treatment
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.) Frequent liquid intake, use of artificial saliva, sugar-free candy, proper brushing habits, daily fluoride (if recommended by dentist)

What survivors can do for dental health

Know your risk and monitor your health

  • Know your risk of developing dental problems. Ask your doctor if you have received treatments that increase your risk for problems with your teeth and gums.
  • Share a copy of your Survivorship Care Plan with health care providers. The plan includes details about your cancer treatment, including blood transfusions, and information about health problems that may occur because of your treatment.
  • 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.

Recommended screenings

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.
Imaging, including a panoramic (“panorex”) X-ray, provides detailed pictures of teeth, roots, and jaws.

Imaging, including a panoramic (“panorex”) X-ray, provides detailed pictures of teeth, roots, and jaws.

Panoramic X-rays allow dentists to look at root development and the strength of the supporting bone.

Panoramic X-rays allow dentists to look at root development and the strength of the supporting bone.

Prevention

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 twice a day with fluoride toothpaste.
  • Place your brush at a slight angle toward the gum when brushing along the gum line.
  • Use a soft bristle toothbrush, as recommended by your dentist.
  • Clean all surfaces of your teeth.
  • Brush your tongue to remove bacteria.
  • Gently floss teeth daily.
  • Use antibacterial, alcohol-free fluoride mouth rinses.
  • Drink liquids often, use artificial saliva, or both.
  • Limit sweets and other foods high in carbohydrates.
  • Do not use tobacco.
  • Drink alcohol in moderation if at all.
Regular dental check-ups every six months and regular imaging of the teeth, roots, and jaw will help screen for dental problems.

Regular dental check-ups every six months and regular imaging of the teeth, roots, and jaw will help screen for dental problems.

Special precautions for dental work

Bacteria that normally enter the bloodstream during dental work may increase the risk of serious infections. Tell your dentist if you have had the procedures or conditions listed below because you may need to take antibiotics before dental work begins.

These conditions include:

  • Surgical removal of spleen (splenectomy)
  • High doses of radiation to the spleen (40 Gy or more)
  • Leaky or scarred heart valve (this can happen after radiation to the chest)
  • Ventricular shunt (surgical placement of a tube that drains fluid from the brain into the heart or venous system)
  • Limb salvage procedure (metal rod or bone graft to replace bone
  • Active chronic graft-versus-host disease

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.

For more information, read Dental Health after Cancer Treatment from the Children’s Oncology Group.

—
Reviewed: June 2020

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