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Other PLAIN summaries
- Asymptomatic coronary artery disease
- Bone problems
- Cancer-related fatigue
- Central precocious puberty – CPP
- Chronic pain
- Craniofacial growth problems
- Dental and oral problems
- Dyslipidemia
- Eye problems
- Gastro-intestinal problems
- Hair loss
- Health promotion
- Hearing problems
- Heart problems
- Higher risk groups
- HP axis problems
- Hypertension
- Impaired glucose metabolism and diabetes
- Kidney problems
- Liver problems
- Lower urinary tract problems
- Lung problems
- Male fertility problems, testosterone deficiency and sexual dysfunction
- Mental health problems
- Neurocognitive problems
- Obstetric problems
- Overweight and obesity
- Peripheral neuropathy
- Premature ovarian insufficiency
- Psychosocial problems
- Spine scoliosis and kyphosis
- Spleen problems
- Stroke
- Subsequent neoplasms:
- Thyroid problems
DENTAL AND ORAL PROBLEMS
This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.
This PLAIN summary is based on the PanCareFollowUp guideline about “Dental and oral problems” [1], which is based on the consensus of different national guidelines.
PLAIN version 2.1: 27/05/2024
Dental and oral problems
A healthy mouth is important for our overall well-being and health. Important parts of the mouth are the teeth, tongue, gums, salivary glands and the jaw. Each tooth has one or more roots by which it is embedded in the gums and the jaw bone. Young children have 20 baby teeth (also called temporary teeth) in total, which fall out and are replaced by 32 adult teeth when they are 6 to 12 years old. This usually happens in two phases: the first phase between approximately 6 and 8 years, and the second phase between approximately 10 and 12 years of age.
Damage to the mouth and/or teeth can cause problems with eating, speaking and may affect overall health and the way you feel about yourself. Problems with the teeth are called dental problems. Problems with other parts of the mouth, such as the gums or tongue, are called oral problems.
Almost everyone experiences one or more dental or oral problems in their lifetime. Common dental and oral problems are a toothache caused by a cavity (a hole within the tooth), inflamed gums, a dry mouth, altered or decreased taste or sensitive teeth. Sometimes the teeth develop in an unusual way.
There are a number of things everyone can do to lower your risk of dental and oral problems, such as adopting or maintaining good hygiene of the mouth, avoiding frequent intake of high sugar foods and visiting a dental professional regularly.
The mouth
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Hover over the numbers in the figure for more information.
Am I at higher risk of dental and oral problems?
Anyone, including people who have never had cancer treatment, may develop dental or oral problems. However, there are some cancer treatments that may increase the risk of having dental and oral problems later in life. The problems that can occur depend on the type of cancer treatment received.
The following treatments can increase the risk of dental and/or oral problems:
- Radiotherapy to areas that include the jaw, mouth and/or salivary glands can cause problems such as a dry mouth, cavities, inflamed gums and early loss of the anchorage of teeth in the jaw, loss of taste, jaw stiffness (not being able to open your mouth fully) and problems with the development of the jaw and teeth.
- Chemotherapy can cause problems such as a dry mouth, cavities, inflamed gums and problems with the development of the jaw and teeth.
- Stem cell transplantation with stem cells from a donor (allogeneic) can cause dental and/or oral problems as this involves high doses of chemotherapy and sometimes also radiotherapy.
You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.
If you experience dental and oral problems, it does not always mean that it was caused by your cancer treatment. Dental and oral problems may have other causes, such as poor hygiene of the mouth.
Stem cell transplantation
Stem cell transplantation means that blood stem cells are taken out of the body of a person and transplanted back into the same person (autologous) or to another person (allogeneic).
This procedure is often used to treat diseases such as leukaemia and lymphoma, and some solid tumours (such as neuroblastoma) as well as certain immune system and genetic disorders.
There are different types of stem cell transplants, including:
- Autologous Transplant: Uses the patient’s own stem cells, which are harvested before treatments like chemotherapy or radiation and then returned to the body to help recover.
- Allogeneic Transplant: Uses stem cells from a donor. The donor can be a relative (often a sibling) or someone unrelated with a matching tissue type.
The blood stem cells can be harvested in different ways. They can either be taken out of the blood stream (peripheral blood stem cell transplantation) or out of the bone marrow (bone marrow transplantation).
During the transplantation process, the patient often undergoes a treatment to kill the diseased bone marrow cells before receiving the new stem cells through an intravenous line, similar to a blood transfusion. After the transplant, it takes time for the new stem cells to grow and start producing healthy blood cells, during which the patient needs close medical care to prevent and manage potential complications, such as infections or graft-versus-host disease (in case of allogeneic transplants).
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
What are the symptoms and signs of dental and oral problems?
There are symptoms and signs that can tell you if you might have dental and/or oral problems. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.
These symptoms and signs may suggest that you have dental and/or oral problems:
- One or more parts of the mouth, jaw or neck feel painful or swollen
- The gums bleed regularly when flossing or toothbrushing
- A dry mouth
- A change in (or loss of) taste
- A (small) wound or ulcer in the mouth which takes a long time (>2 weeks) to heal
- Dental cavities
- Not losing baby teeth between 6 and 12 years of age
- Crowded, discoloured or misshapen teeth
Small dental and oral problems are usually temporary and the problems will usually go away on their own. However, if you experience any of these symptoms or signs, please contact a dentist or follow-up care specialist. Most dental and oral problems can be treated or prevented from getting worse over time.
Symptoms and signs
What happens if I have dental and oral problems?
If you have dental and/or oral problems, your dentist may treat the problem right away or may refer you to a specialist. Depending on the symptoms and/or signs you experience, you may be referred to a:
- Dental hygienist (healthcare professional specialised in dental care)
- Orthodontist (dentist specialised in dental and jaw abnormalities)
- Prosthodontist (dentist specialised in restoring oral function by replacing missing or lost teeth)
- Oral and maxillofacial surgeon (surgeons specialised in the area of the mouth)
- Dietician (specialist who advise on eating habits and lifestyle)
The specialist may do further testing and discuss different treatment options with you.
What else can I do?
Knowing that you may be at increased risk of dental and oral problems can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.
To lower the risk of dental and oral problems, it is very important to live a healthy lifestyle. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.
It is also important to keep your mouth healthy, especially if you received cancer treatment. It is advised to brush your teeth twice a day for more than 2 minutes with a toothpaste that contains fluoride and to use interdental cleaning devices such as toothpicks or interdental brushes once a day. In some cases, particularly after radiotherapy involving the head and neck, specific preventative measures (such as using high fluoride containing prescription toothpaste) may be necessary. It is recommended to see a dentist at least once every 6-12 months even if you aren’t experiencing dental/oral issues.
It is important that you are aware of the possibility of developing dental and oral problems and that you know the symptoms and signs. If you have any further questions or the information in this brochure concerns you, please contact your dentist, general practitioner or follow-up care specialist.
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
Where can I find more information?
You may find more information about dental and oral problems online. However, it is important to be aware that this information is not always up to date or accurate.
Some sources of further information are:
- Leukaemia and Lymphoma Society: Here you can find more information about cancer treatment and oral health
On this website, you can also find more information related to this topic:
Please note
This PLAIN summary is based on the PanCareFollowUp guideline about “Dental and oral problems” [1], which is based on the consensus of different national guidelines.
While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.
Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.
No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.
The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.
[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext.