Childhood cancer and its affect on dental health

My daughter has been treated for childhood cancer. She seems to be doing well right now, but I wonder how the disease and treatment have affected her dental health.

Question:

Dear Parent,

I am encouraged to hear that your daughter seems to be doing well now. Cancer treatment can be very tricky. There are several outcomes of treatment that can occur, both systemically and orally.

Surgery can cause disfigurement, nerve damage, and loss of function. Radiotherapy can cause loss of hair, growth impairment, and impairment of endocrine (including salivary gland), liver, lung, and kidney functions. Chemotherapy can also damage some of these same functions. Effects of chemotherapy and radiation therapy may be additive.

Because dental development is in progress during cancer treatment, certain conditions can arise. The severity of these conditions may depend upon several factors, including the type and location of the malignancy, age of the child, type of surgery, amount of radiation therapy, type and dosage of chemotherapeutic drugs, oral health, and dental treatment before, during, and after cancer treatment. Growth impairment may lead to orofacial assymetry, dry mouth, cavities, trismus, and other dental concerns.

If your daughter underwent radiation therapy, some salivary gland dysfunction may be apparent; however, this problem is generally temporary in children because less radiation is used for children than adults, and the glands have a greater capacity to regenerate in children. Tooth enamel formation may be reduced or absent. The shape of the crowns of the teeth may be changed -- for example, the teeth may appear smaller. The roots may be shorter, more tapered, and show more curvature. Certain teeth may even be rootless. Generally, tooth loss and eruption follows the normal pattern.

Chemotherapy may lead to other dental concerns.These may include small teeth, large pulp chambers, short roots, and delayed eruption of teeth. Opaque spots in the enamel, lack of enamel formation or weak enamel formation, and increased susceptibility to decay are also possible outcomes of treatment. This increase in decay may or may not be directly related to the chemotherapeutic agents; it may be indirectly related due to lack of enamel formation, change in normal bacteria present in the mouth, decrease in saliva, dietary practices, and home-care.

In general, children under the age of six years who have been treated for cancer will show more severe dental changes. Because most children receive both chemotherapy and radiation therapy, it may be difficult to determine the exact effects of each. Higher dosages tend to show more severe changes.

I hope all goes well with your daughter and your family. Obviously, follow-up with health care providers, including your dentist, is very important. Preventive care is also imperative. If dental anomalies do occur, cosmetic dentistry, orthodontics, and other dental care can be provided as necessary.

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