When a child enters a cancer battle, families rarely consider how treatments will affect teeth. However, life-saving measures, particularly chemotherapy and radiation, have immediate and future consequences on oral health. 

Dr. Carolyn A. Kerins, associate professor and graduate program director in the pediatric dentistry department at Texas A&M University College of Dentistry in Dallas, said a dental visit should be scheduled before treatment starts. The dentist needs to ensure the child’s teeth and gums are stable and eliminate any potential sources of infection, including cavities. 

“Ideally, all children should have a dental home and see the dentist every six months,” Kerins said. “The dental home includes preventative care services such as fluoride and sealants, restorative services and emergency care.” 

For children facing cancer, it’s imperative. Chemotherapy involves drugs that affect the entire body, and the effects and extent depend on the timing of the cancer treatment and the stage of tooth development. 

“Cancer treatment can halt the cellular division of tooth buds that are responsible for forming the permanent teeth,” said Kerins, who’s also on staff at Children’s Health in Dallas and specializes in complicated pediatric cases. “Calcification of the permanent teeth starts before birth for some teeth, and complete tooth formation up to eruption may take three to five years. 

“Since chemotherapy stuns the process, a child may experience delayed loss of primary teeth and formation of permanent teeth and the emergence of those permanent teeth.” 

Radiation’s effects depend on the dose and time. Radiation to the head and neck causes more issues to teeth and mouth, breaking down oral tissue, salivary glands and bone. This can lead to mucositis – inflammation of a mucous membrane – dry mouth, increased cavities and tissue death. 

“If all the permanent teeth are fully formed and erupted, the child is still at increased risk for tooth decay and periodontal disease,” Kerins said. 

If radiation is at a high dose or starts when permanent teeth are developing, teeth can stop growing and likely won’t recover, she said. If a tooth develops, it’s often without a full root and could fall out. In some cases, teeth may be extracted before cancer treatments because they aren’t restorable because of cavities or an infection in a tooth’s nerve. 

Other common dental problems are dry mouth, which can lead to more cavities; mouth sores and ulcers; altered sense of taste; fungal infections; oral pain and jaw tightening. 

“Patients are encouraged to reach out to their dentist if they experience these symptoms,” Kerins said. 

Cancer treatment is a long process. 

“It’s usually a two-year experience,” she said. “Kids are going to miss school… the peer groups may shift, often complicating parenting. A strong social support network surrounded by a team of physicians and dentists will yield the best outcome.”