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Oral complications in long-term survivors of childhood cancer

More attention needs to be paid to oral health during and after childhood cancer treatment. Awareness among oral health professionals, pediatric health care providers, children and parents is important, says PhD student Juliette Stolze. 

Dentist and PhD student Juliette Stolze, who works two days a week at the Máxima Center and the Academic Centre for Dentistry (ACTA) in Amsterdam, says: ‘Good preventive education and advice to both child and parents, is an important part of the oral care guideline. Good oral hygiene during childhood cancer treatment is extremely important, because it can reduce the severity and duration of mucositis (painful sores in the mouth). Good oral hygiene also reduces the risk of infections and cavities (caries). ' 

Preventive screening 
Juliette: 'It is important that every child receives a check-up by the (hospital-affiliated) dentist during the initial admission and prior to the treatment. Before oncological treatment starts, potential dental foci can be treated or eliminated. When chemotherapy is planned, a clean, healthy mouth is important to prevent infections in the oral cavity when there is a low immunity and damaged oral mucosa. In addition, the need to extract teeth can be avoided at a later stage, when platelets and granulocytes are low and risk of bleeding, infection and poor wound healing can occur. Furthermore, it is important to remove factors that can damage the oral mucosa such as orthodontic brackets. When radiotherapy in the head and neck area is planned, preventive screening also focuses on long-term problems, such as radiation caries.’ 

Dry mouth 
Childhood cancer therapy can cause long-term effects on the oral health. Juliette Stolze studied the prevalence (how common it is) and risk factors of dry mouth, dental problems, subjective oral health and oral health-related quality of life. The PhD student says: ‘Our results on oral health in 249 survivors of childhood cancer are revealing. Dry mouth is common, especially among survivors who received radiotherapy of the head and neck region (45.9%), and this has adverse effects on oral health. Abnormalities in dental development occur in one third of the survivors. Risk factors include younger age at diagnosis (<3 years) and therapy with a specific group of cytostatics (alkylating agents in particular). Despite these complications, we observed a relatively good perceived oral health and quality of life. Survivors may be used to having a dry mouth, so they will not notice it. However, oral problems do deserve attention. If survivors have a diminished salivary flow rate, the risk of caries and fungal infections is increased. And dental abnormalities, such as missing teeth or too short tooth roots, can also cause problems.' 

Better follow-up care 
Juliette Stolze: 'The conclusion of my dissertation is that oral complications due to cancer therapy at a young age occur frequently among survivors . Awareness is therefore important, among oral health professionals, pediatric oncologists, nurses and survivors themselves. Regular visits to the dentist should definitely be part of follow-up care, so that oral problems can be prevented where possible or detected at an early stage, or during long-term follow-up care. This is why the nurses, led by Ida Ophorst, continue to work on the implementation of the new oral care guideline in the Máxima Center. Attention to the mouth in the early stages will also pay off in the long term, and that is very important if you read my research results.' (photo credits: Joost Hoving) 

Promotion Juliette Stolze 
‘Oral health in cancer survivors. Especially in those treated during childhood' 
September 19, 4 pm  
Agnietenkapel, Amsterdam  
Supervisors: Dr. Henk Brand, co-supervisors: Dr. Dorine Bresters, Dr. Judith Raber-Durlacher