Special Care for Ca Children
Children receiving chemotherapy and/or radiation therapy are at risk for the same oral complications as adults. Other actions to consider in managing pediatric patients include the following:
Extract loose primary teeth and teeth expected to exfoliate during cancer treatment.
Remove orthodontic bands and brackets if highly stomatotoxic chemotherapy is planned or if the appliances will be in the radiation field.
Monitor craniofacial and dental structures for abnormal growth and development.
Dental Care for Oral Complications of Cancer Treatment
Oral Mucositis: Culture lesions to identify secondary infection. Prescribe topical anesthetics and systemic analgesics. Consult the oncologist about prescribing antimicrobial agents for known infections. Have the patient avoid rough-textured foods and report oral problems early.
Xerostomia/salivary gland dysfunction: Advise the patient to soften or thin foods with liquid, chew sugarless gum, or suck ice chips or sugar-free hard candies. Suggest using commercial saliva substitutes or prescribe a saliva stimulant.
Taste changes: Refer to a dietitian.
Etched enamel: Advise the patient to rinse the mouth with water and baking soda solution after vomiting to protect enamel.
Complications Specific to Chemotherapy
Neurotoxicity: Provide analgesics or systemic pain relief.
Bleeding: Advise the patient to clean teeth thoroughly with a toothbrush softened in warm water; avoid flossing the areas that are bleeding but to keep flossing the other teeth.
Complications Specific to Radiation
Demineralization and radiation caries: Prescribe daily fluoride gel applications before treatment starts. Continue for the patient’s lifetime if changes in quality or quantity of saliva persist.
Trismus/tissue fibrosis: Instruct the patient on stretching exercises for the jaw to prevent or reduce the severity of fibrosis.
Osteonecrosis: Avoid invasive procedures involving irradiated bone, particularly the mandible.