Oral and dental late effects in survivors of childhood cancer: a Children's Oncology Group report.
OBJECTIVE
Multi-modality therapy has resulted in improved survival for childhood malignancies. The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers provide practitioners with exposure- and risk-based recommendations for the surveillance and management of asymptomatic survivors who are at least 2 years from completion of therapy. This review outlines the pathophysiology and risks for oral and dental late effects in pediatric cancer survivors and the rationale for oral and dental screening recommended by the Children's Oncology Group.


METHODS
An English literature search for oral and dental complications of childhood cancer treatment was undertaken via MEDLINE and encompassed January 1975 to January 2013. Proposed guideline content based on the literature review was approved by a multi-disciplinary panel of survivorship experts and scored according to a modified version of the National Comprehensive Cancer Network "Categories of Consensus" system.


RESULTS
The Children's Oncology Group oral-dental panel selected 85 relevant citations. Childhood cancer therapy may impact tooth development, salivary function, craniofacial development, and temporomandibular joint function placing some childhood cancer survivors at an increased risk for poor oral and dental health. Additionally, head and neck radiation and hematopoietic stem cell transplantation increase the risk of subsequent malignant neoplasms in the oral cavity. Survivors require routine dental care to evaluate for potential side effects and initiate early treatment.


CONCLUSIONS
Certain childhood cancer survivors are at an increased risk for poor oral and dental health. Early identification of oral and dental morbidity and early interventions can optimize health and quality of life.
Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Stanford University, 1000 Welch Rd, Suite 300, Palo Alto, CA, 94304, USA, effinger@stanford.edu.
Karen E
KE
Effinger
Cesar A
CA
Migliorati
Melissa M
MM
Hudson
Kevin P
KP
McMullen
Sue C
SC
Kaste
Kathy
K
Ruble
Gregory M T
GM
Guilcher
Ami J
AJ
Shah
Sharon M
SM
Castellino
D002648:Child; D003729:Dental Care / Q000379:methods*; D006801:Humans; D009369:Neoplasms / Q000503:physiopathology* / Q000628:therapy*; D017741:Survivors