Salivary and Dental Complications in Childhood Cancer Survivors Treated With Radiation Therapy to the Head and Neck: A PENTEC Comprehensive Review

Prevalence and Risk Factors for Hyposalivation and Xerostomia in Childhood Cancer Survivors Following Different Treatment Modalities—A Dutch Childhood Cancer Survivor Study Late Effects 2 Clinical Study (DCCSS LATER 2)

“…Over 75% of childhood cancer survivors (CCS) experience one or more late effects arising from childhood cancer treatment [ 1 ]. Amongst these late effects, survivors may develop salivary gland dysfunction, such as hyposalivation (decreased salivary secretion) and/or xerostomia (the subjective feeling of a dry mouth) [ 2 , 3 , 4 ]. Salivary gland dysfunction is a significant and probably underestimated late effect and may negatively affect general health [ 5 , 6 ], as saliva maintains oral health by protecting the oral mucosa and teeth.…”

Long-Term Effects of Childhood Cancer Treatment on Dentition and Oral Health: A Dentist Survey Study from the DCCSS LATER 2 Study

“…A recent systematic review by Milgrom et al presented data on dental developmental effects in CCSs who received RT to the head and neck, focusing on dose–volume parameters [ 20 ]. Risk factors included higher radiation dose to the developing teeth (>20 Gy) and a lower age at treatment.…”

“…Because the outcome was common, and in such situations the odds ratios generated by logistic regression analyses overestimate the relative risk, we used Poisson regression models with log-link function and robust standard errors to calculate relative risks [ 27 ]. Potential risk factors were included in the multivariable model based on univariable analyses, previous studies [ 8 , 19 , 20 ], and clinical relevance, resulting in the variables gender, age at diagnosis, H&N RT, treatment with vinca alkaloids, treatment with epipodophyllotoxins, and the cyclophosphamide equivalent dose (CED) [ 28 ]. Additionally, we evaluated the contribution of other chemotherapy classes (anthracyclines, platinum compounds, and antimetabolites), but those were not included in the final model, as they were not significantly associated with DDDs in univariable analyses.…”

“…Developmental disorders of the teeth in CCSs are often a result of cancer treatment during tooth development, due to the disruption of ameloblast and odontoblast activity [ 17 ]. In CCSs, a younger age at diagnosis [ 7 , 8 , 13 , 18 , 19 ], total body irradiation (TBI) or a higher dose of radiation exposure to the head and neck region [ 7 , 8 , 20 ], and treatment with a high dose of alkylating agents [ 8 , 21 ] or vinca alkaloids [ 22 , 23 ] were reported to be associated with increased risk for long-term oral problems and dental abnormalities. However, most of these studies were based on univariable comparisons, without adjusting for other potential risk factors.…”

Anticancer Therapy and Dentition: An Overlooked Late Adverse Effect in Childhood Cancer Survivors

“…The risk factors for DDDs include (a) age below 3 y while receiving ACT, (b) dose-dependent alkylating agents including cyclophosphamide (> 4 g/m 2 ), and (c) radiotherapy dose exceeding 20 Gy to head and neck region [3,4]. Few recent studies have suggested age below 4 y and radiotherapy dose exceeding 20 Gy to predict DDDs better than the dose of radiotherapy alone [4,5]. In the current protocols for acute lymphoblastic leukemia (ALL), prophylactic cranial radiotherapy is no longer included.…”