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Table 5. Dental Late Effectsa
Late Effects
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Causative Treatment
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Signs and Symptoms
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Screening and Diagnostic Tests
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Management and Intervention
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aAdapted from Schwartz et al.[37]
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Xerostomia (decreased salivary gland function) |
Radiation: >40 Gy and >50% of gland irradiated |
Decreased salivary flow, dry mouth, altered taste perception, dental decay, Candida (thrush) |
Dental examination, salivary flow studies, attention to early caries, periodontal disease |
Encourage meticulous oral hygiene, saliva substitution, prophylactic fluoride, dietary counseling regarding avoiding fermentable carbohydrates, nystatin for oral candidiasis, pilocarpine |
Abnormal tooth and root development |
Chemotherapy: Vincristine, actinomycin D, cyclophosphamide, 6-mercaptopurine (6-MP), procarbazine, nitrogen mustard (HN2) |
Enamel appears pale, teeth appear small, uneven; malocclusion |
Dental examination every 6 months with, attention to early caries, periodontal disease, and gingivitis, Panorex/bite/wing radiographs baseline (age 5–6 years) |
Careful evaluation before tooth extraction, endodontics and orthodontics, fluoride, antibiotics as needed for risk of infection (e.g., trauma) |
Radiation: Generally 10 Gy can destroy developing roots |
References
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Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.
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