Coping when your child has cancer

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Dental problems

Some people may develop dental problems as a late effect of treatments for cancer during childhood. Treatments that can lead to problems with the teeth and jaws include chemotherapy, radiation therapy and stem cell transplant.

How the teeth and jaws work

The mouth, including the teeth and jaws, is the first part of the digestion process. In the mouth, food is mixed with saliva and then the teeth chew it. This process starts breaking down the food before it is swallowed.

The upper jaw bones, or maxilla bones, are the largest bones in the face. They support the upper teeth. The lower jaw bone, or mandible, supports the lower teeth. The upper and lower jaws move to open and close your mouth so you can chew food and speak. Muscles control the movement of the jaw bones.

Diagram of the teeth and jaws

Types of dental problems

People who are treated for cancer as children may have one or more dental problems as a late effect of treatment.

The following dental problems can develop after chemotherapy or stem cell transplant for childhood cancer:

  • greater risk of cavities
  • shortening or thinning of teeth roots
  • absence of teeth or roots
  • white or discoloured patches on the teeth
  • grooves or pits in the teeth
  • easy staining of the teeth

Dental problems that can develop as a late effect of radiation therapy for childhood cancer include:

  • dry mouth, or xerostomia, due to lowered saliva production
  • greater risk of cavities
  • shortening or thinning of teeth roots
  • absence of teeth or roots
  • small teeth
  • delayed eruption of permanent teeth
  • white or discoloured patches on the teeth
  • grooves or pits in the teeth
  • easy staining of the teeth
  • early loss of teeth or baby teeth don’t fall out
  • greater risk that the teeth will be sensitive to hot and cold
  • trismus, which is difficulty opening the jaw
  • temporomandibular joint (TMJ) dysfunction, which causes pain in front of the ears
  • overbite or underbite
  • abnormal growth of bones in the face and neck
  • hardening of the jaw muscles (called fibrosis)
  • gum disease
  • osteoradionecrosis

Osteoradionecrosis is the death of bone caused by radiation. It is a rare late effect that most often occurs when someone treated with radiation has a dental procedure involving the jaw, such as having a tooth pulled or other surgery. The lower jaw is the most common bone affected by osteoradionecrosis. Very rarely, osteoradionecrosis can start in the upper jaw.

Find out more about osteoradionecrosis and trismus.

Causes

Dental problems may occur as a late effect of some treatments for childhood cancers, including:

  • radiation therapy to the mouth, head or neck
  • chemotherapy (tooth development problems are more likely to occur in children under the age of 5 years or whose adult teeth haven’t yet formed)
  • stem cell transplant

Different aspects of stem cell transplant can lead to dental problems. People who are given azathioprine (Imuran) to help prevent rejection have a greater risk for dental problems. People who develop chronic graft-versus-host disease (GVHD) from stem cell transplant may also develop dental problems such as cavities and gum disease.

Symptoms

Signs and symptoms of dental problems include:

  • redness, tenderness or puffiness of the gums
  • easy bleeding of the gums
  • painful teeth
  • tooth sensitivity

People treated for childhood cancer who received radiation therapy to the head and neck or who have chronic graft-versus-host disease (GVHD) after a stem cell transplant may have a greater risk of developing oral cavity cancer. Symptoms of oral cavity cancer include:

  • a sore in the mouth that doesn’t heal or bleeds easily
  • a change in the colour of the tissues in your mouth
  • a lump, thickening or rough spot in the mouth
  • soreness or numbness in the mouth or on the lips

Tell your doctor or healthcare team if you or your child develops these symptoms after treatment for a childhood cancer.

Diagnosis

Dental problems are usually diagnosed by:

  • x-rays to assess tooth and jaw development
  • examining the teeth and mouth

Preventing dental problems

Taking care of your teeth and gums is always important. But dental care is especially important if you received radiation therapy or chemotherapy at a young age.

Talk to your dentist about how you can keep your teeth and mouth as healthy as possible. Your dentist may recommend doing the following:

  • Have regular follow-ups with your dentist.
  • Brush your teeth at least 2 times each day. Floss your teeth 1–2 times each day. Use a fluoride rinse or gel each day.
  • Drink liquids often.
  • Use artificial saliva.
  • Limit sweets and carbohydrate-rich foods.
  • Don’t use tobacco products.
  • Limit the amount of alcohol you drink.

Managing dental problems

Most people who are treated for cancer during childhood will have a panorex x-ray, which is an x-ray of the upper and lower jaw. This x-ray can help your dentist, orthodontist or oral surgeon plan treatment for any dental problems that develop. For example, the panorex x-ray will show if the teeth, roots and supporting bones are strong enough for braces.

Treatments will depend on the types of dental problems that develop and may include:

  • caps or crowns for adult teeth that don’t develop normally
  • reconstructive surgery to correct poor bone growth of the face or jaw
  • stretching exercise for the jaw to improve your ability to open your mouth
  • bonding (a thin coating of plastic material) applied to the surface of the teeth to cover flaws

If you had high doses of radiation to the face or mouth, your dentist will talk to you and the radiation oncologist about the risk of osteoradionecrosis before doing any dental surgery.

Follow-up

All people who are treated for childhood cancer need regular follow-up. The healthcare team will develop a follow-up plan based on the type of cancer, how it was treated and your needs.

People who receive radiation therapy to the head or neck area or stem cell transplant should get dental checkups every 6 months. Make sure you tell your dentist about all the treatments you received.

Follow-up may include the following:

  • examining the teeth and gums
  • dental x-rays
  • examining the mouth for signs of oral cavity cancer

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