Chew on This

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Chew on This

The enamel covering our teeth may be the hardest substance in the human body, but it can wear out — especially among those who have survived cancer

Are You at Risk?

Everyone should see a dentist regularly, but childhood cancer survivors need to be especially vigilant with their dental care.

Risk factors for dental problems include:

  • Treatment with chemotherapy before permanent teeth were formed, especially if treatment happened before age 5
  • Radiation that included the mouth or salivary glands
  • Treatment with azathioprine, sometimes given to patients receiving a hematopoietic cell transplant (HCT)
  • Chronic graft-versus-host disease associated with HCT

Dental Issues to Watch For

Dental problems that may result from chemotherapy or HCT and radiation during childhood include:

  • Increased risk for cavities
  • Shortening or thinning of teeth roots
  • Absence of teeth or roots
  • Difficulty with tooth enamel development resulting in discolored patches, grooves, pits or easy staining of teeth. These problems may be repaired by bonding.

If you had a bone marrow or stem cell transplant using a donor, it is important to let your dentist know so he or she can check for signs of graft-versus-host disease.

The Littlest Chompers

If a child received radiation to the mouth or salivary glands, watch out for these potential issues:

  • Small teeth, which might need caps or crowns to improve the function and look
  • Early loss of teeth
  • Baby teeth not falling out
  • Delayed development or eruption of teeth
  • Increased tooth sensitivity to hot and cold
  • Xerostomia, or dry mouth, due to decreased saliva production, which increases risk of cavities. Drinking more fluids, using artificial saliva and limiting candy or sweets can help.
  • Alteration in taste
  • Trismus, the limited ability to fully open the mouth. Talk to your dentist or an occupational therapist to learn stretching exercises.
  • Temporomandibular joint dysfunction, which causes pain in front of the ears
  • Bite problem such as overbite or underbite
  • Abnormal growth of bones in the face and neck
  • Periodontal (gum) disease that can cause gums to shrink away from the teeth and lead to infection in the bone that supports the roots. This condition, known as periodontitis, may be prevented by proper brushing and flossing of the teeth and gums at least once a day.
  • Problems with the jawbone healing after dental surgery or tooth extraction should be discussed by a dentist with a radiation oncologist prior to any dental surgery.

No matter your current health, make sure your dentist has your health history and the treatment you received on file. See your dentist at least every six months, with an oral cancer screening performed each time. Notify your dentist immediately if you develop any signs of infection such as redness, tenderness, excessive bleeding of the gums, painful teeth or increased areas of sensitivity.

Source: Children’s Oncology Group

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