There has been a lot of media press lately about the empire state building refusing to go gold for childhood cancer, but how much do you actually know about childhood cancer? Did you know that approximately 15,780 children each year in the United States are diagnosed with cancer? Or that the general category for childhood cancers encompasses 12 types of cancers? The most common childhood cancers include lymphoma, leukemia, brain and other central nervous system tumors, neuroblastoma, rhabdomyoscarcoma, retinoblastoma, bone cancer and wilms tumor.
How are pediatric cancers treated?
Childhood cancers may be treated differently than adult cancers, and thus though some of the side effects associated with both cancer therapies are similar, pediatric oncologic therapy also presents with different side effects.
Did you know that chemotherapy may affect dental growth?
Pediatric cancer therapy is associated with oral and dental developmental side effects that are more commonly seen in patients who have received therapy before the age of six. The developmental side effects may include:
Microdontia. Teeth may develop to be smaller in size.
Hypodontia/tooth agenesis. Permanent teeth may fail to develop.
Crown and root developmental anomalies. Teeth may develop with blunted roots, altered crown height or shape as well as enamel hypoplasia. Root shape or the pulp chambers may be altered. Additionally, root apices may close prematurely.
Reduced mandibular length and height.
It is important to note that the extent of these side effects are temporally dependent and are associated with the patient's age and stage of development at which he/she received the chemotherapy or radiation treatment as well as the dosage and frequency of the therapy.
What other oral side effects may present with pediatric cancer therapies?
Oral side effects include mucositis (mouth sores), taste alteration, oral infections, neurotoxicity, trismus, oral graft versus host disease, osteoradionecrosis of the jaw and medication related osteonecrosis of the jaw.
What To Do?
1. Remove Orthodontic Appliances. It is often recommended that poor fitting orthodontic appliances such as braces and space maintainers are removed until after completion of chemotherapy as poor fitting appliances may injure the oral mucosa. Additionally, if the patient has poor oral hygiene removal of orthodontic appliances is recommended to prevent infection and bacterial growth. Nonetheless, if the patient has excellent oral hygiene and the appliance fits well, removal may not be necessary and should be discussed with the patient's oncology team.
2. Avoid wearing removable appliances when mucositis is present. Patients should not wear removable appliances when their counts or low or when they have mucositis.
3. Visit a dental oncologist before therapy. If possible, it is recommended that patients visit a dentist with knowledge of how chemotherapy and radiation treatment may affect the patient's oral and dental health before undergoing therapy.
4. Frequent dental recall visits.
5. Brush brush brush. Practicing excellent oral hygiene is extremely important to help reduce the risk of infection, severity and duration of mucositis as well as the risk of dental decay.
Further reading
Dentistry, American Academy Of Pediatric. Guideline on Dental Management of Pediatric Patients Receiving Chemotherapy, Hematopoietic Cell Transplantation, And/or Radiation Therapy (n.d.): n. pag. AAPD. Web. <http://www.aapd.org/media/policies_guidelines/g_chemo.pdf>.