Dental and Craniofacial Effects on Childhood Cancer Survivors

Abstract

The availability and adoption of modern therapeutic protocols for childhood cancer have continuously reduced the mortality rate of childhood malignancies in most countries over the past decades. Children being treated for cancer are actively growing, creating unique problems not only in the short-term but also in the long-term development of both the orofacial hard and soft tissue. Complications during and after cancer therapy depend on the type of malignancy, age at diagnosis, and the drugs used during the therapy. The adverse oral effects of irradiation have long been known, and high-dose chemotherapy can cause similar oral late effects, such as dental disturbances, delayed tooth eruption, oral mucosa changes, and craniofacial effects. There are many protocols to prevent acute oral toxicity and infections like mucositis, candidiasis, or hyposalivation. The aim of this chapter is to define the short-term and long-term effects of cancer therapy on the oral health.

Long term oral and dental effects in adolescents who were treated for cancer in childhood

“…In the current study, 62 teeth of 21 patients (17%) displayed some form of hypocalcification and hypoplasia. Several studies indicated higher rates of this dental alteration than observed in our cohort 14,15,22,42 . Twenty-one patients (17.4%) in the current study displayed microdontia in contrast to 0.8%-1.7% 38 in healthy populations.…”

“…Acute oral effects include: mucositis, bleeding, taste alterations, secondary infections, salivary gland dysfunction, periodontal conditions and neurotoxicity 2,9,10 . Late oral phenomena include: exacerbated dental caries, temporomandibular dysfunction, osteoradionecrosis, cranio-dental development, dental anomalies and oral graft versus host disease 2,[9][10][11][12][13][14][15][16] . Children are particularly vulnerable to the harmful effects of radiotherapy and chemotherapy.…”

“…The continuation of severe or long-term upsets may damage root formation, thus leading to a shortened or tapered root. Root development plays a dominant role in the eruption; disturbance to a tooth root might impair tooth eruption and occlusion 14,17 . The first sign of dental disturbances can be expected within one or two years of anticancer treatment 14 .…”

“…Root development plays a dominant role in the eruption; disturbance to a tooth root might impair tooth eruption and occlusion 14,17 . The first sign of dental disturbances can be expected within one or two years of anticancer treatment 14 . Reported abnormalities include: hypodontia / agenesis (missing teeth), microdontia (the formation of small teeth), damage to root development (premature closure of the apex, tapering roots with apical constriction, root stunting, and V-shaped degenerated root), hypoplasia and hypocalcification (including damage to the enamel structure, resulting in incomplete calcification), over-retention of primary teeth, impaction, premature eruption, malocclusion, decreased temporomandibular joint mobility, trismus and facial deformities 2,6,14,15,23,24,26,[29][30][31][32][33][34][35][36][37][38] .…”

Long Term Dental Effects in Adolescents Who were Treated for Cancer in Childhood

“…The continuation of severe or long-term upsets may damage root formation, thus leading to a shortened or tapered root. Root development plays a dominant role in the eruption; disturbance to a tooth root might impair tooth eruption and occlusion 9 . The rst sign of dental disturbances can be expected within one or two years of anticancer treatment 9 .…”