In developing countries, childhood cancer is the leading cause of non-infectious disease deaths among children and adolescents.
It strikes most frequently in the first year of life, followed by the ages of two to three.
According to the 2007-2011 Malaysian National Cancer Registry, the most common childhood cancer among children aged 14 years and below in Malaysia is leukaemia, followed by brain tumours and lymphoma.
Previously, deaths due to childhood cancer were attributed to several factors, such as lack of parental awareness of the disease, delay in diagnosis, limited access to treatment and fewer specialised healthcare providers.
However, with the recent advances in medicine and surgery, the prognosis and outcomes for childhood cancer has significantly improved, resulting in higher survival rates among such patients.
These more aggressive medications and treatments have concomitantly resulted in an increase in adverse side effects among cancer survivors.
A diagnosis of cancer is devastating for families of affected children, and many naturally focus on the medical aspects of cancer treatment, overlooking the significance of oral health.
The oral-mucosal, or mouth, region is extremely sensitive to anti-cancer medications.
Oral healthcare providers, including paediatric and general dentists can support the oncology team by managing oral complications from cancer therapy, as well as delivering basic oral care to affected children and providing emergency dental treatment if necessary.
Child cancer patients are three times more prone to developing acute oral complications, compared to adults.
Common acute oral manifestations of cancer therapy in children include, but are not limited to:
This is irritation or tenderness of the oral tissue.
It ranges in appearance from a mild redness in the oral cavity to ulcers and bleeding.
Mucositis is considered the most distressing oral complication of cancer therapy.
It not only causes pain and bleeding, but can also lead to difficulty in eating and inability to swallow.
For children with mucositis, treatment is mostly palliative, i.e. treating the pain, but not the cause of the pain.
To soothe the tenderness, topical anaesthetic gel can be applied.
Drinking ice water or sucking ice chips also help to numb the mouth to lessen the pain.
In severe, painful cases of mucositis, systemic analgesics like pills or intravenous (IV) drugs can be prescribed.
This may lead to the emergence of opportunistic fungal infections, most commonly, candidiasis.
Antifungal therapy should be started as soon as the signs and/or symptoms of fungal infection are spotted, so as to prevent more widespread infection throughout the body.
Localised fungal infections can be treated with a topical antifungal agent like creams or ointments.
This is a condition where there is reduced saliva production, leading to dryness of the mouth.
The children most affected by this are those undergoing head and neck radiotherapy as the area covered by the treatment usually includes the major salivary glands.
Temporary relief of the dryness can be provided through application of salivary substitutes, frequent sipping of water and placement of a humidifier by the bedside at night.
Taste changes in child cancer patients is usually the result of damaged taste buds and salivary glands following radiotherapy.
The condition is however, temporary and will usually improve within three months of completing the therapy.
Children who receive head and neck radiotherapy may develop trismus due to stiffness of the masticatory jaw muscle.
Trismus is a painful restriction in opening the mouth due to spasms of the jaw muscles.
The presence of this condition makes routine tooth-brushing, speaking, eating and dental treatment difficult.
Trismus is usually managed through mouth opening and stretching exercises, which should be continued for a few months after cancer therapy is completed.
In conclusion, it is important for dental healthcare professionals to educate patients and parents about the importance of maintaining good oral hygiene and to create awareness about the oral complications of cancer therapy, so as to provide better and holistic management for child cancer patients.
Dr Ahmad Faisal Ismail is a paediatric dentist and assistant professor at the International Islamic University Malaysia (IIUM). For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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