Dental Health After Childhood Cancer

Taking care of your teeth and gums is important for everyone. But it is even more important for survivors of childhood cancer who received certain types of cancer treatment that raise risk for dental problems.

Am I at Risk?

If you received the following cancer treatments you are at risk for dental problems:

  • chemotherapy before your permanent teeth were fully formed, especially if you were younger than 5 years old
  • radiation that included the mouth, salivary glands, or both
  • treatment with azathioprine, which is sometimes given to patients receiving bone marrow or stem cell transplants
  • bone marrow or stem cell transplants that caused chronic graft-versus-host disease

What Dental Problems Can Occur?

Dental problems vary based on the type of treatment that you received.

Chemotherapy or Bone Marrow/Stem Cell Transplant

Problems that can occur due to chemotherapy or a bone marrow or stem cell transplant include:

  • increased risk for cavities
  • shortening or thinning of the roots of the teeth
  • absence of teeth or roots
  • white or discolored patches on the teeth, grooves and pits in the teeth, or easy staining of the teeth (due to problems with development of tooth enamel)
  • oral cancer

Radiation to the Mouth, Salivary Glands, or Both

Problems that can occur due to radiation to the mouth, salivary glands, or both include all of the problems listed above plus these:

  • small teeth
  • early loss of teeth
  • baby teeth not falling out
  • problems with tooth development or delayed permanent teeth
  • increased risk for tooth sensitivity to hot and cold sensations
  • dry mouth (xerostomia)
  • alteration in taste
  • limited ability to fully open the mouth (trismus)
  • TMJ (temporomandibular joint dysfunction) causing pain in front of the ears
  • bite problems, such as overbite or underbite
  • abnormal growth of bones of the face and neck
  • gum disease
  • problems with healing of the jawbone after dental surgery or getting teeth pulled (see related Health Link: “Osteoradionecrosis“)

What Can I Do To Prevent Dental Problems?

Take good care of your teeth and gums, and see your dentist routinely to prevent cavities and gum disease. Follow these recommendations, unless your dentist tells you otherwise.

  • See your dentist at least every six months. Your visits should include oral cancer screening.
  • Have a panorex x-ray done before dental or orthodontic procedures to assess root development of your teeth and determine if any changes need to be made to your dental treatment plan.
  • Brush your teeth at least twice a day using fluoride toothpaste. Brush at a slight angle toward the gum when brushing along the gum line.
  • Gently floss your teeth once or twice a day.
  • Use antibacterial, alcohol-free fluoride mouth rinses.
  • Drink liquids often, use artificial saliva, or both.
  • Apply fluoride rinses or gels daily, if recommended by your dentist.
  • Limit sweets and foods high in carbohydrates.
  • Don’t use tobacco products and use alcohol in moderation, if at all. Alcohol can increase risk for other problems following childhood cancer, so ask your doctor first. Also, tobacco in any form, especially with alcohol, greatly increases your risk for oral cancer.
  • Tell your dentist right away if your mouth or gums are red, tender, or bleeding a lot, or if your teeth hurt or have increased sensitivity. These are signs of infection.
  • Notify your dentist right away if you notice a sore that does not heal or that bleeds easily; a change in the color of your mouth tissues; a lump, thickening, or rough spot in your mouth; or pain, tenderness, or numbness in your mouth or on your lips. Though unlikely, these symptoms can be signs of oral cancer.

What If I Have Dental Problems?

Treatment options for dental problems vary. If your permanent teeth do not develop normally, you may need caps or crowns to improve their function and your smile. Sometimes surgery is needed to correct poor bone growth of the face or jaw. Stretching exercises for the jaw may help you to open your mouth more fully. Bonding may help improve crooked or small teeth. If you need braces, your dentist will take a panorex x-ray to see if the teeth, roots, and supporting bone are strong enough. If you had high-dose radiation to the face or mouth your dentist will review your potential for bone healing problems (osteoradionecrosis) following dental surgery. If you had a bone marrow or stem cell transplant from a donor other than yourself, your dentist will check for changes that indicate chronic graft-versus-host disease.

Drinking liquids often and using artificial saliva can help relieve symptoms of dry mouth.

What Should I Talk with My Dentist About?

Give your dentist a summary of your cancer treatment to make sure that he or she knows your health history and the cancer treatments that you received.

Also, be sure to let your dentist know if you have had the following health conditions or procedures:

  • a shunt that drains fluid from the brain
  • replacement of bone with a metal rod or bone graft (limb salvage procedure)
  • a leaky or scarred heart valve (sometimes happens after radiation to the chest)
  • surgical removal of the spleen
  • high doses of radiation to the spleen
  • active chronic graft-versus-host disease following bone marrow or stem cell transplant

In any of these situations, bacteria that normally enter the bloodstream during dental work may increase risk for serious infections. Ask your dentist if you need to take antibiotics before dental work to help prevent a possible infection. See related Health Links: “Splenic Precautions,” “Limb Salvage after Bone Cancer,” and “Heart Health after Childhood Cancer.”

Where Can I Learn More about Dental Health?

For more information on dental health after childhood cancer visit the American Dental Association’s website at

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