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Effect Of Chemotherapy On Teeth

My child needs chemotherapy. How is that going to affect their teeth?

What is cancer?

Cancer occurs if some of the body’s cells divide and multiply uncontrollably. This excessive growth of cells may result in the formation of tumours, masses of cancer cells, or tissue lumps. Cancer may happen anywhere in the body and spread to other parts of the body. These abnormal cells can destroy normal body tissue and are considered a leading cause of death. However, cancer’s survival rates have increased due to the advances in cancer screening, prevention, and treatment.

What are the most common options to treat cancer?

Common treatment: Chemotherapy and Radiation therapy

Depending on the type of cancer the person has and how advanced the condition is, cancer treatments will vary.

Cancer treatments may include one or a combination of the following:

  • Chemotherapy
  • Radiation therapy
  • Surgery
  • Targeted therapy
  • Hormone therapy
  • Immunotherapy

Side effects

A patient may experience many late or long-term side effects after cancer treatment. Cancer treatment could cause damage to different body organs such as the brain, nerves, kidneys, reproductive organs, salivary glands, mouth, gums, teeth, lungs, or thyroid gland. Cancer treatments can also cause low blood cell counts, which can eventually cause easy bleeding from the nose, mouth or, gums.

Our body requires its white blood cells to fight infection. A person may experience a decrease in their white blood cells, called neutropenia, during or after cancer treatment, which can elevate their risk of developing serious infections.

Some medications will lower the speed of cancer cells spreading to the bones during the treatment. These medications, in rare cases, can cause a condition called “MRONJ”. MRONJ is an adverse drug reaction that could cause damage to the jawbone. A person may experience loose teeth and exposed bone around the jaw due to MRONJ.

The most common types of cancer treatments are chemotherapy and radiation therapy; each has its side effects on the person’s body. Some but not all types of cancer and cancer treatments will have oral and dental problems. Your health care team will give you more information on your risks of experiencing cancer treatment side effects.

Dental problems and oral side effects of cancer and cancer treatment

Late effects of childhood cancer treatment

Some cancer treatment side effects may show up during your child’s treatment or after that and will disappear after a short while. However, some side effects may appear months or even years after your child’s cancer treatment. They are referred to as “late effects”.

By arranging follow-up sessions after your child’s cancer treatment, your child’s doctor will be able to identify and manage these late effects. Your child’s age, type of cancer and cancer treatment they had, and the amount of chemotherapy or radiation your child has received will typically determine the follow-up sessions’ schedule.

Chemotherapy drugs will kill cancer cells; however, cancer treatment, in general, can cause damage to healthy cells leading to both short-term side effects and late effects. Both chemotherapy and radiation therapy may cause your child to experience late effects.

Cancer treatment oral complications

Direct complications

Direct side effects are those that are caused by cancer treatment.

Indirect complications

Indirect complications refer to those caused by side effects of cancer treatment.

Dental problems and oral side effects caused by cancer and childhood cancer treatment and a stem cell transplant

It’s not unusual for cancer patients to experience dental problems or oral side effects to the mouth, jaws, or salivary glands. Patients with head and neck cancer have a higher risk of experiencing dental problems and oral side effects.

What is graft versus host disease?

Patients with chronic graft versus host disease from a stem cell transplant may experience dental problems like decay or gum disease. Chronic graft versus host disease is a severe complication that may affect people with a stem cell from a donor.

Graft versus host disease (GVHD) occurs if the donor’s cells attack and damage the patients’ healthy cells. The condition may cause inflammation, tooth decay, dry mouth, mouth sores, gum disease, and having trouble swallowing.  Low-level laser therapy can help relieve mouth sores, inflammation, or pain for people affected by oral GVHD.

What is a stem cell transplant?

Radiation treatment and high dose chemotherapy will kill cancer cells, but they can also destroy healthy cells. A stem cell transplant is a medical treatment that involves the infusion of healthy blood-forming stem cells into a patient’s body. Stem cell transplant replaces damaged stem cells with healthy ones (blood-forming cells).

People will receive high dose chemotherapy before a stem cell transplant; a person has a higher risk of developing dental problems if they receive high dose chemotherapy. Patients may also receive radiation therapy before a stem cell transplant. A stem cell transplant is also called a bone marrow transplant.

Generally, the health care team for childhood cancer treatment, especially head and neck cancer, may include a team of doctors and specialists, general dentists, dental specialists, oral surgeons, speech therapists, oral oncologists, periodontists, maxillofacial prosthodontists, and other health professionals. Your child needs their oral health care team to take care of their dental care before, during, or after receiving childhood cancer treatment, especially if you have a higher risk of showing oral side effects and dental problems.

A cancer patient may experience the following dental problems and oral side effects after childhood cancer treatments:

  • Infection
  • Pain in the mouth
  • Mouth sores
  • Jaw muscles pain
  • Jaw muscles stiffness
  • Problems with salivary glands
  • Damage to the nerves
  • Difficulty swallowing
  • Taste loss or changes in taste
  • Increased risk of cavities
  • Tooth staining
  • Appearing white patches on the teeth
  • Shortened tooth roots or absence of the roots
  • Grooves in the teeth

If the child receives radiation therapy and chemotherapy drugs, they have an increased risk of experiencing dental problems. Regular dental checkups and follow-up sessions with the cancer care team will help cancer patients to deal with late effects and problems better. If your child has received radiation therapy to the head and neck, they will need a dental visit every six months.

Oral side effects and dental problems caused by chemotherapy

Chemotherapy oral health side effects

Patients receiving chemotherapy may experience the following oral complications and dental problems.

Side effects will typically disappear shortly after the therapy is over, and the person’s normal cells begin to recover.

  • Infection
  • Bleeding in the mouth (gums)
  • Mouth and gum pain
  • Mouth sores
  • Dry mouth
  • Taste loss
  • Burning sensations in the tongue
  • Tooth decay
  • Throat irritation
  • Gum sensitivity
  • Issues with permanent teeth (adult teeth) eruption
  • Tooth development problems
  • Issues with tooth enamel development

Your child has an increased risk of experiencing dental problems and oral side effects such as tooth decay and gum disease if they receive high dose chemotherapy. Washing your child’s mouth with mouth rinses may help with some mouth irritation. Children younger than five years old have a higher risk of developing dental problems after cancer treatment because their permanent teeth have not developed fully yet.

Problems may include:

  1. Abnormal bone growth in the neck area or face
  2. Small teeth
  3. Overbite or underbite
  4. Baby teeth that won’t fall

Oral side effects caused by radiation therapy

Radiation therapy oral health side effects

Radiation therapy is another common childhood cancer treatment. Radiation therapy to the head and neck, to the mouth, jaw, and salivary glands, can cause a range of dental problems.

Radiation therapy can cause damage to salivary glands and interfere with saliva production. We need saliva to keep our mouth moist and avoid a dry mouth. Enough saliva flow will prevent tooth decay, infection, gum disease, and bad breath. A decreased saliva flow will result in a dry mouth. A dry mouth can cause many dental problems for the child, such as gum disease, tooth decay.

Radiation therapy to the head and neck area, mouth, salivary glands, or jaw may cause:

  • Gum disease
  • Tooth decay
  • Dry mouth
  • Mouth sores
  • Changes of taste
  • Infection
  • Increased risk of cavity
  • Shortened tooth roots or absence of the roots
  • Appearing white patches on the teeth
  • Tooth staining
  • Increased risk of tooth sensitivity
  • Premature tooth loss
  • Issues with permanent teeth (adult teeth) eruption
  • Tooth development problems
  • Abnormal bone growth in the face or probably neck area
  • Difficulty opening the mouth (painful)
  • Small teeth
  • Jaw muscles stiffness

 

Radiation therapy can also cause bone death. Radiation therapy to the head and neck can interfere with the tongue’s abilities to taste, resulting in experiencing taste loss or changes in taste.

How to manage the side effects of cancer treatment

Managing or preventing side effects and oral complications of cancer and cancer treatment

Complications can linger recovery, but they can be managed with the help of the health care team.

Before starting cancer treatment, good oral hygiene and dental checkups can decrease your child’s risk of developing many oral complications and improve their oral health. Children should brush their teeth using a soft-bristled toothbrush twice a day to keep their teeth healthy.

A paediatric dentist can also do a thorough oral examination of your child’s mouth before starting cancer treatment and let you know if your child requires any dental work before the treatment.

  • Your child’s dentist may also decide to perform fluoride treatment to strengthen your child’s teeth enamel during and after radiation therapy. They may ask you to apply a little fluoride gel to your child’s teeth to make them less susceptible to tooth decay.
  • Mouth rinses may be prescribed to reduce mouth and gums irritation caused either by chemotherapy or radiation therapy.
  • Radiation therapy may cause damage to your child’s salivary glands, leading to a dry mouth. Artificial saliva, good oral hygiene, chewing sugar-free gums, or sugar-free candy may also be recommended to lessen dry mouth.
  • To lower the pain and discomfort caused by mouth sores, you can ask your child to gargle their mouth with saltwater.
  • You may be asked to provide your child with soft foods rather than crunchy or hard foods that require more chewing. It can help with mouth and jaw pain.
  • Try to limit your child’s intake of acidic and sugary foods to prevent tooth decay and gum disease.
  • Dental treatment such as dental crowns may be needed if your child has abnormal permanent teeth eruption.
  • If your child has small teeth, the dentist may suggest composite crowns or veneers.
  • Your dentist may need to refer your child to an oral surgeon to perform reconstructive surgery to correct poor bone growth in your child’s face or jaw.

If your child is experiencing weight changes after starting cancer treatment, talk to their health care provider to help your kid maintain a healthy weight.