Caries disease in childhood cancer patients: a literature review

Miquelão, Julia Pianezzer; Barros, Julia Funez; Longo, Bruna Cristina

doi:10.1590/1981-86372024004520240037

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Review • Rev Gaúch. Odontol. 72 • 2024 • https://doi.org/10.1590/1981-86372024004520240037 linkcopy

Caries disease in childhood cancer patients: a literature review

Doença cárie em pacientes com câncer infantojuvenil: revisão de literatura narrativa

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This study aims to present the prevalence of dental caries in childhood cancer patients, emphasizing the effects of antineoplastic therapy. To carry out the study, a search strategy was adopted that covered books from 2017 to 2022 and articles available in databases, published between 1997 and 2021, in English and Portuguese. In recent years, there has been an increase in the incidence of malignant neoplasms in pediatric patients. The most common are leukemias, lymphomas, and tumors of the central and sympathetic nervous systems. The treatment of these diseases is antineoplastic therapy, which aims to combat cancer cells. However, it can cause unwanted effects such as systemic, craniofacial, and dental changes. The most common oral manifestations are caries, microdontia, hypodontia, root changes and taurodontism. The relationship between tooth decay and childhood cancer is still not well understood, as factors such as diet and oral hygiene can play a confounding role in the development of tooth decay. Antineoplastic therapy increases the patient’s risk of developing caries disease, however, it has not yet been proven to be a disease-modifying factor, so additional studies must be carried out.

Indexing terms
Dental caries; Dental plaque; Surviving cancer

Author, Year	Number of patients evaluated (CC/healthy)	Assessment method	Statistical difference between groups
Duggal et al. [¹²], 1997	46/46	DMFT	Yes	The authors believe that this result was because the CC did not visit the dentist regularly. They also suggest that many professionals are unprepared to care for these patients. In addition, diet changes in this group can increase dental caries.
Alpaslan et al. [⁸], 1999	30/20	DMFT/ dmft	No	The researchers obtained the following results: patients who underwent radiotherapy treatment have a greater risk of developing dental caries, due to the increase in bacterial species like Streptococcus mutans and lactobacillus. However, they did not observe a statistical difference between the groups and suggest that this result may have been influenced by the frequent use of mouthwashes, such as 0.12% chlorhexidine, and dietary restrictions in CC.
Oguz et al. [⁹], 2004	36/36	deft/DMFT	No	The following conclusions were obtained: there was no significant difference between the test and control group, which may be related to the restriction of sugary foods, oral hygiene care during the AT, and prescription of 0.12% chlorhexidine in the CC group.
Avsar et al., 2007	96/96	DMFT	Yes	Despite the difference between groups, the authors suggest that chemotherapy alone does not appear to cause adverse effects on dental caries. They suggest the difference is possible because of a period of mixed dentition, poor oral hygiene, oral flora changes, and ingestion of cariogenic foods.
Çubukçu & Sevinir [¹⁰], 2008	62/62	DMFT/ dmft	Yes	The study data, it was observed that there is a higher prevalence of dental caries in patients who underwent head/neck irradiation and should therefore have periodic monitoring, as well as a deficiency in the oral health care of deciduous teeth compared to permanent teeth, which may be associated with poor oral hygiene and xerostomia.
Hegde et al. [¹¹], 2011	90/30	DMFT/ DMF	Yes	Those authors believe that the increase in inflammation of the oral mucosa contributed to a deficiency in oral hygiene and, consequently to the increase in dental caries.
Nemeth et al. [¹³], 2013	38/40	DMFT	Yes	Despite the statistical difference between the groups, the authors reached the following conclusion that the increase in dental caries in the group with cancer is not related to AT, but rather to the lack of oral hygiene care.
Çetiner et al. [⁴], 2018	53/40	DMFT/def	No	The research identified that there is no correlation between AT and the presence of dental caries. The authors believe that the results can be attributed to the continuous use of chlorhexidine rinses and the dietary restrictions of the CC.
Proc et al. [¹⁴], 2019	41/150	DMFT	Yes	The results of the study indicate that socioeconomic factors influence the prevalence of dental caries, as well as there is a need for cooperation between oncologists and dentists to prevent oral diseases resulting from AT since their caries process is more active compared to their healthy peers.
Shayani et al. [⁶], 2021	23/46	DMFT	Yes	Researchers understand that changes in oral microflora, reduced salivary flow, consumption of sugary foods, vomiting episodes that cause demineralization of the structure, and chemotherapy agents are predisposing factors for dental caries in CC.

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[1] Note: AT: antineoplastic therapy; CC: childhood cancer; DMFT: permanent teeth index, D: decayed, M: missing, F: filled, T: teeth, deft: decíduos teeth index, d: decayed, m: missing, f: filled, t: teeth.