Late Effects of Treatment for Childhood Cancer

Table 5. Dental Late Effects^a

Late Effects Causative Treatment Signs and Symptoms Screening and Diagnostic Tests Management and Intervention

^aAdapted from Schwartz et al.[37]

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

Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.