Dental and Oral Health in Childhood Cancer

dental

Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Dental and oral health includes the well-being of the entire mouth, including the teeth, gums, lining of the mouth (mucosa), and salivary glands (the glands that produce saliva). Various cancer treatments may affect your child’s dental and/or oral health.

Dental and oral side effects may make it difficult for your child to eat, chew, talk, or swallow.

Although most of us only know about dentists and oral hygienists, there are also various other dental health professionals who can help with your child’s oral care before, during, and after cancer treatment, including:

  • Oral Oncologist: A dentist who specializes in the dental and oral health of people with cancer
  • Oral Surgeon: A dentist who specializes in surgery of the mouth and jaw
  • Periodontist: A dentist who specializes in diagnosing and treating gum disease
  • Prosthodontist: A dentist who specializes in replacing teeth or other structures in the mouth

There are various side-effects caused by cancer treatment that can affect the mouth, including:

  • Dry Mouth (Xerostomia)
  • Mouth Sores (Mucositis)
  • Tooth Decay
  • Difficulty Swallowing (Dysphagia)
  • Difficulty Chewing or Opening the Mouth
  • Infection
  • Bone Disease
  • Inflammation or Pain in the Lining of the Mouth and Tongue

Some of the side effects may disappear once the treatment is finished, while others may be long-lasting or even permanent.

 

Causes

Not all cancer treatments affect the mouth, teeth, and jaw. However, the following treatments may cause specific dental and oral side effects:

  • Radiation Therapy to the Head and Neck: Side effects from radiation therapy to the head and neck may include bone disease, dry mouth, loss of taste, mouth and gum sores, tooth decay, and stiffness in the jaw. These side effects may be temporary or can continue for several years after treatment. It is a good idea to speak to your child’s dentist before they undergo such treatment, as this may help reduce the risk of potential cancer treatment-related side effects. The dentist may also recommend that your child use special fluoride treatments to help prevent dental decay and infection that can be caused by not producing enough saliva during radiation therapy.
  • Chemotherapy: Common side effects of chemotherapy include changes in taste, mouth sores, mouth and gum pain, peeling or burning of the tongue, and infection. Chemotherapy sometimes also causes a temporary decrease in your child’s ability to produce infection-fighting cells, so a visit to the dentist before treatment begins is a good idea to treat and eliminating any possible areas of infection in the mouth or teeth. Fixed orthodontic appliances like braces should be removed before chemotherapy begins. Dental and oral side effects from chemotherapy usually disappear soon after treatment ends.
  • Stem Cell/Bone Marrow Transplantation: The high-dose chemotherapy that is usually given before a stem cell transplant may cause dental and oral side effects as mentioned above, and in addition, graft-versus-host disease (GVHD) – a potentially serious complication of stem cell transplantation – may cause dry mouth, cavities, sores in the mouth, sensitivity to spicy or acidic foods, and difficulty swallowing due to a decrease in saliva.
  • Bone-Modifying Drugs: Medications like bisphosphonates and other newer drugs are sometimes used to prevent or treat osteoporosis and other types of bone loss caused by cancer, but they unfortunately do have an uncommon but serious side-effect; osteonecrosis of the jaw (ONJ). Symptoms of ONJ include pain, swelling, and infection of the jaw; loose teeth; and exposed bone. It is vital that you take your child to their dentist before treatment commences to make sure there are no areas of infection.
  • Other Medications: Other medications that help manage cancer symptoms and side effects, such as pain medications and mouth rinses can cause dental and oral side effects like dry mouth and tooth discolouration.

 

Management and Treatment

Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment, therefore it is important that you let your child’s doctor, nurse, dentist, or another member of their health care team know immediately if they are experiencing any pain, bleeding, decrease in the ability to open their mouth, or swelling in the mouth.

Common treatments for dental and oral side effects may include:

  • Mouth Rinses: Mouth rinses that contain salt and baking soda may help treat mouth sores. There are also various prescription rinses that may soothe sore spots.
  • Pain Medications: Your child’s doctor or dentist may prescribe pain medication to treat pain from mouth sores; these medications can be placed directly on the sores, taken orally (by mouth), or be given through an IV.
  • Antibiotics: Antibiotics, antiviral drugs, and/or antifungal drugs are used to treat mouth infections.
  • Liquids: Drinking water and sugar-free drinks may help manage dry mouth. Sucking on ice chips may also help. Avoid giving your child liquids that will dry out the mouth, such as soda, fruit juices.
  • Medications: Medications that stimulate the production of saliva may be recommended for some individuals to help prevent or minimise “drug mouth” while others may be given topical oral gels. Your child’s oncologist may also prescribe other medications for dry mouth caused by radiation therapy to the head and neck.

 

Prevention

It is important that you make an appointment with your child’s dentist at least four weeks before they are to start any cancer treatment.

If your child needs to have a dental procedure, such as the removal of a tooth, ask your dentist how soon after the procedure they can start cancer treatment.  Many oral oncologists recommend allowing at least two weeks for healing between dental surgery and the start of cancer treatment.

It is also important to talk with your child’s dentist or another member of their health care team about which mouth problems you should tell their dentist about right away.  If you didn’t have a chance to take your child to see a dentist before they started their cancer treatment, take them to see one as soon as possible.

Regular communication with your child’s health care team is important for preventing dental and oral side effects. The following tips may also help improve your child’s oral health and prevent side effects during treatment:

  • Brushing and Flossing: It is important that your child gently brush their teeth twice daily and floss regularly. It may also help to soak an extra-soft toothbrush in warm water to soften the bristles before they brush. If they are receiving chemotherapy, the doctor may give you special instructions to help them reduce the risk of bleeding and infection.
  • Diet: Avoid extremes in your child’s diet. Try giving them foods that are soft and mild. Extremely hot, cold, spicy, acidic, or crunchy foods may irritate their mouth.
  • Bone Health: Ensuring that your child gets enough Vitamin D and Calcium each day will help promote a strong, healthy jaw and teeth. Dairy products are good sources of Calcium and Fortified Vitamin D. Other food choices may include fortified fruit juice and fortified breakfast cereals. Speak to your child’s doctor before giving them any supplements.

 

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