Purpose 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 pan el 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. Addition ally, head and neck radiation and hematopoietic stem cell transplantation increase the risk of subsequent ma lignant 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.

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Background The impact of temporal changes in cancer therapy on health status among childhood cancer survivors has not been evaluated. Objective Compare proportions of self-report of adverse health status outcomes across three decades among childhood cancer survivors. Design Cross-sectional Setting 27 North American institutions Participants 14,566 adults, ≥5 year survivors (median age 27, range 18-48 years) treated 1970-1999 Measurements Patient-report of poor general or mental health, functional impairment, activity limitation, cancer-related anxiety or pain were evaluated as a function of treatment decade, cancer treatment exposures, chronic health conditions, demographics, and health habits. Results Despite reductions in late-mortality and proportions with severe, disabling or life threatening chronic health conditions (33.4% among survivors treated 1970-79, 21.0% among those treated 1990-99), proportions reporting adverse health status did not decrease by treatment decade. When compared to those diagnosed 1970-79, survivors diagnosed 1990-99 were more likely to report poor general health (11.2% vs. 13.7%, p < 0.001) and cancer-related anxiety (13.3% vs. 15.0%, p < 0.001). From 1970-79 to 1990-99, the proportions reporting adverse outcomes were higher (p < 0.001) among leukemia (9.5% vs. 13.9%, poor general health) and osteosarcoma (23.9% vs. 36.6%, pain) survivors. Temporal changes in treatment exposures were not associated with changes in proportions reporting adverse health status. However, smoking, not meeting physical activity guidelines, and being either underweight or obese were associated with poor health status. Limitations The considerable improvement in survival among children diagnosed with cancer in the 1990s compared to those diagnosed in the 1970s makes it difficult to definitively determine the impact of risk factors on later self-reported health status without considering their impact on mortality itself. Conclusions Because survival rates following a diagnosis of childhood cancer have improved substantially over the past thirty years, this population now includes persons who would have died in earlier eras. Unfortunately, self-reported health status among those that do survive has not improved. This is despite evolution of treatment designed to reduce toxicities, and is an important reminder that even in the modern era, cancer cure is not without consequences.”