Childhood cancer, while a challenging diagnosis, has seen significant advancements in treatment and survival rates. In high-income countries, cancer remains the leading disease-related cause of death among children, yet approximately 80% of children diagnosed with cancer each year survive [3]. Globally, however, survival rates can vary significantly, with about 25% surviving in low- and middle-income countries [3]. As survival rates improve, the focus of care extends beyond achieving a cure to encompass reducing long-term toxicities and improving the overall quality of life for young patients and survivors [4, 7]. A crucial, yet sometimes overlooked, aspect of this comprehensive care is oral and dental health [1].
Oral Health: An Essential Part of Cancer Care
Oral health care is not merely an adjunct but an integral component of the interprofessional collaborative care provided to children and adolescents diagnosed with cancer [1]. The mouth serves as a gateway to the body, and its health can significantly impact a child’s ability to eat, speak, and maintain overall well-being during a vulnerable period. Poor oral health can lead to debilitating complications, especially when a child's immune system is weakened by cancer treatments [1]. Addressing dental needs proactively and consistently helps prevent infections and other issues that could delay or complicate cancer therapy.
Before Treatment: Proactive Dental Planning
The journey of oral care for a child with cancer ideally begins even before cancer treatment starts. A thorough baseline oral and dental health assessment is critical to identify and address any existing issues [1]. The primary goal of this pre-treatment evaluation is to prevent severe complications that could arise during the immunosuppressed phase of cancer therapy [1]. Ideally, all necessary dental treatments, such as fillings or extractions, should be completed before the initiation of immunosuppressive cancer treatments [1]. This proactive approach minimizes the risk of infections or other dental emergencies when the child's immune system is compromised, which could otherwise lead to treatment delays or more serious health problems.
During Treatment: Managing Oral Complications
Cancer therapies, particularly chemotherapy, can have significant side effects on a child’s oral health. One common and often debilitating condition is oral mucositis, which involves inflammation and painful sores in the mouth and along the gastrointestinal tract [2]. This can make eating, drinking, and even speaking extremely difficult and uncomfortable for children receiving cytotoxic cancer therapy [2]. Throughout the treatment period, counseling on preventive oral health practices is imperative [1]. This includes gentle but consistent oral hygiene, which may involve specialized rinses or soft toothbrushes, tailored to the child's specific needs and tolerance. Managing these complications effectively helps maintain the child's nutritional intake and comfort, supporting their overall resilience during therapy.
After Treatment: Long-Term Oral Health for Survivors
With high survival rates for many childhood cancers, attention to long-term health and quality of life for survivors is paramount [3, 4]. Childhood cancer survivors may experience various late effects from their treatments, which can manifest months or even years after therapy concludes [1, 6]. While some treatments are known to cause late effects like hearing loss [6], oral complications can also persist or develop over time [1]. These might include issues with tooth development, jaw growth, salivary gland function, or increased risk of dental decay. Ongoing monitoring and support for oral health are crucial for these survivors, ensuring that any emerging issues are addressed promptly to maintain their long-term well-being and quality of life [4]. Regular dental check-ups and adherence to preventive strategies remain vital throughout their lives.
Collaborative Care for Best Outcomes
Providing optimal oral and dental care for children with cancer requires a collaborative effort from a multidisciplinary team. This team typically includes pediatric oncologists, dentists, oral surgeons, and primary care providers [1, 4]. General pediatricians play a significant role in supporting healthy lifestyles for childhood cancer survivors, offering standard nutrition and physical activity recommendations [4]. This integrated approach ensures that all aspects of a child's health, including their oral health, are continuously monitored and addressed throughout their cancer journey, from diagnosis through treatment and into long-term survivorship [1, 4]. By working together, healthcare professionals can significantly improve the health outcomes and quality of life for these resilient young patients.
Sources
1. Oral and dental considerations in pediatric cancers. https://pubmed.ncbi.nlm.nih.gov/31989506/
2. Prevention of gastrointestinal side-effects in paediatric oncology: what are the guidelines? https://pubmed.ncbi.nlm.nih.gov/28333866/
3. Global child health priorities: what role for paediatric oncologists? https://pubmed.ncbi.nlm.nih.gov/18799306/
4. Pediatric Oncology and Obesity: An Introduction for General Pediatricians. https://pubmed.ncbi.nlm.nih.gov/37542412/
5. Auditory late effects of childhood cancer therapy: a report from the Children's Oncology Group. https://pubmed.ncbi.nlm.nih.gov/20194279/
6. Clinical research tools in pediatric oncology: challenges and opportunities. https://pubmed.ncbi.nlm.nih.gov/31939050/