Jill Meyer-Lippert and Jennifer Brown are co-authors of a series of in-depth articles on the oral side effects of cancer treatment and the importance of getting prompt medical/dental treatment. Treatment delays can compromise outcomes. Being a knowledgeable patient is a must!
This article focuses on the impact of childhood cancers on oral health.
Childhood cancers (also known as Pediatric Cancers) are different from cancers affecting adults, even if the tumors occur in the same areas of the body. Children are most likely to be affected by blood cancers, brain and other central nervous system (CNS) tumors, and neuroblastomas.
Treatments for pediatric cancers also differ, often being more aggressive in nature than those administered to treat tumors in adults. Therefore, some of the side effects experienced by children are unique including those within the mouth. Short-term and long-term side effects experienced can depend on:
- The type and location of cancer
- The age of the child when treated
- The child’s overall health before treatments
- The child’s genetic make-up that may increase risks for developing certain health problems
Typical recommendations to reduce oral side effects can be especially challenging for children, as they are dependent on family and caregivers to be educated on the subject and assist with oral care during a very physically, emotionally and financially stressful experience. It’s important to remember that “baby teeth” are important and any signs of decay or irritation need to be addressed.
All links providing additional information in the text below are designed for the adult survivor and should be altered as needed to accommodate the child’s age, dexterity and abilities. While oral side effects are not limited to the following treatments, we will focus on a few that are commonly used for Pediatric Cancers and pose the greatest risks for oral complications.
Chemotherapy can induce several side effects, including dry mouth, mouth sores (oral mucositis), loss of taste/taste changes and an increased risk for tooth decay and infections. While these complications may be limited to the time while in active treatment, they can cause pain and discomfort, compromise nutrition and can cause alterations or delays in treatment. Long-term damage to teeth and gum health can also occur, potentially requiring time consuming and costly dental care long after cancer treatments are complete.
Many factors determine which side effects occur, including the type of chemotherapy, the dosage, the duration of treatments, and the current status of overall and oral health of the patient. Effective oral care and plaque removal can also have a tremendous impact.
Some of the short-term and long-term oral side effects of chemotherapy may be minimized or possibly avoided with a combination of preventive professional dental care, diligent homecare and product selection.
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Stem Cell Transplant
Stem cell transplants are also known as bone marrow transplants. Preparing for a stem cell transplant requires high doses of chemotherapy and, in some cases, full body radiation to kill the cancer cells within the bone marrow. Healthy blood-forming cells are then infused to replace the cancerous cells and rebuild a stronger immune system.
The process to prepare for a transplant leaves the patient at very high risk for all of the above-mentioned side effects associated with chemotherapy. It is estimated that while approximately 40% of those receiving standard dose chemotherapy will experience problems with mouth sores, up to 80% of those receiving a stem cell transplant will develop some level of oral mucositis. The sores are not only a concern for pain and nutrition but can also be a significant source for infection.
Those who receive a stem cell transplant from a donor can be at risk for a long-term condition known as Chronic Graft vs. Host Disease (cGVHD) which occurs when the donated immune cells attack the individual who received the transplant. Graft vs. Host Disease can affect many areas of the body including the mouth. Symptoms may range from nonpainful lacey patches appearing inside the cheeks to severe oral dryness and ulcerations. While there is no cure, problems resulting from Graft vs. Host need to be closely monitored and treated appropriately to avoid damage to teeth, oral tissues and infection. Those with cGVHD can also be at increased risk for oral cancer. Screenings for oral cancer are recommended at least once per year.
If treatments include radiation to the head and neck region, salivary glands can be irreversibly damaged causing permanent issues with dry mouth.
Radiation to the head and neck can cause muscles that control opening and closing the mouth or swallowing to become rigid and not function properly. This may lead to issues with eating, speaking and the ability to perform effective oral hygiene. Early intervention with exercises can help to keep these muscles functioning well.
Those who have received radiation to the head and neck at an early age can be more susceptible to developing oral cancer as an adult. Regular oral cancer screenings by a dental professional are a must.
Other long-term oral complications:
Survivors of Pediatric Cancers are susceptible to an array of long-term physical and emotional affects that are not typically seen in survivors of adult cancers. Treatments can affect growth and development of many parts of the body including teeth and oral structures, which may cause:
- Small, misaligned or missing teeth.
- Discolored or misshapen teeth
- Tooth enamel that is not properly formed, causing teeth to decay easily or be overly sensitive to temperatures
- Roots of the teeth that are short or incompletely formed, making the survivor more susceptible to tooth loss as they age
It is important to monitor the development of the jaw, along with the formation and eruption pattern of the permanent teeth. Early recognition of problems may help with the planning process and when it is most appropriate for dental and orthodontic specialists to intervene.
Ideally, treatment for Childhood Cancers would be approached by a team of professionals, including oral healthcare professionals, to address dental needs and provide education with individualized prevention and management protocols. When possible, this should be done prior to the start of treatment to minimize risk and the severity of side effects. If this is not offered through the facility and physicians who are providing cancer therapy, it is wise for the newly diagnosed to seek guidance from dental professionals who are knowledgeable in the field known as Dental Oncology.
Knowledge is power. Understanding potential complications of cancer therapies is the best defense to reduce your risks. A proactive and preventive approach to oral health is vital to reduce the impact of these life changing side effects.