50
Children with Cancer
Introduction
The paediatric dentist plays an important role in diagnosis, prevention, stabilisation and treatment of the oral and dental problems that can compromise the child’s quality of life before, during and after cancer treatment. It is essential to have an understanding of the impact of the condition and its treatment on the child’s general heath, and the implications of oral health and comfort, and provision of dental treatment.
Treatment of Childhood Cancers
A combination of the following treatments is used: chemotherapy, radiotherapy, surgery and bone marrow/stem cell transplantation with or without total body irradiation. Chemotherapy and radiotherapy can have profound impact on oral tissues (Table 50.1) and also on provision of dental care.
Table 50.1 Oral effects of cancer treatments.
| Chemotherapy | Radiotherapy |
| Infections: fungal, viral, Toxoplasma, or bacterial Acute dental infections Chronic periapical infections can become acute Ulcers and mucositis Bleeding and marginal gingivitis, petechiae, ecchymoses, bulla formation Xerostomia can lead to caries and oral infections Trismus Pain in the jaw Delayed and abnormal development Septicaemia can be spread from oral infection |
All effects of chemotherapy can also occur with radiotherapy. Specific issues with radiotherapy are: infections radiation caries pulp pain and necrosis tooth hypersensitivity trismus risk of osteoradionecrosis osteomyelitis if bone is affected sialadenitis |
| Long-term oral effects | Long-term oral effects |
| Dental abnormalities such as: hypoplasia, microdontia taurodontism failure of teeth to develop root constrictions |
Delayed dental development V-shaped roots Altered root morphology Small crown, incomplete calcification |
Issues That Need to Be Considered by Dentists
- The child has been diagnosed with a life-threatening condition. An empathetic approach is required.
- Some forms of cancer may, and frequently do, have oral manifestations.
- The cancer, in particular those involving the haemopoietic tissues, may lead to the child’s immune system being compromised (direct immune suppression).
- Most treatment protocols causes indirect immune suppression which can be severe and will have implications for dental treatment (Table 50.1).
- Many treatment protocols for the cancer cause oral side-effects.
Dental Management for C/>
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