This study investigated the dental health of children (aged 1–14 years) diagnosed with cancer 4–36 months earlier. Sixty patients were examined and interviewed; 43% had untreated decay and only 35% had seen a dentist since their malignancy had been diagnosed. A significant source of bacterial infection is not being treated in this at risk population. The level of dental disease and lack of dental prevention indicates a need to integrate medical and dental care.
- dental disease
- dental treatment
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This study aimed to investigate the dental health of patients attending a regional oncology centre, and their use of dental services. The dental health of children living in the catchment area of the Royal Manchester Children’s Hospital is reported to be the worst in England, with half of the children aged 5 years having two or more decayed teeth.1 To date, studies have focused on the oral side effects of cancer treatment but of equal concern is the presence of dental disease that may lead to acute inflammation and infection.2 Extensive dental decay can lead to the death of a tooth, thereby creating a potential focus of infection. An acute infective episode can be life threatening, it causes pain, and disrupts normal oral function and therefore quality of life. Children who are long term survivors of paediatric malignant disease exhibit a wide range of disturbances in the oral cavity.3 Both the hard and soft tissues of the mouth are affected; consequently regular dental monitoring is required to identify problems early and minimise the risk of disease.
Dental treatment is complicated by malignancy and its treatment, both for patients undergoing treatment and for children in full remission and cured of their malignancy.
The University of Manchester’s Unit of Paediatric Dentistry and the oncology department at the Royal Manchester Children’s Hospital began a collaboration in 1996. This led to a protocol—agreed by members of the medical, nursing, and dental team—to investigate the dental health of patients being treated for childhood cancer. (The protocol included the sampling procedure and methods of data collection.) All patients attending consultant clinics over a set period were examined by a dentist trained to record the presence of untreated decay and the level of oral hygiene. The examiner, using a structured interview with both the patient and parents, recorded the family’s experience of dental services and dental behaviour since cancer had been diagnosed. This produced an unselected quasi random sample of the total population.
Sixty children aged between 1 and 14 years (mean 6.2 years) with a history of cancer of 4–36 months were examined. Untreated decay was diagnosed in 26 children, and 20 patients had visible plaque on their teeth with evidence of gingivitis.
Forty six children claimed to be registered with a provider of primary dental care; however, only 21 reported that they had been examined by their dentist since being diagnosed with cancer. Eight patients had experienced problems gaining access to dental care, and at the time of the interview 18 claimed to be experiencing oral problems.
Twenty five children reported receiving preventive dental advice. Only three were using fluoride supplements at the time of the interview, although most patients (42) claimed to brush at least twice a day.
Over half of the patients or parents had specific questions relating to the effect of the disease or its treatment on the appearance and quality of teeth. Twenty one children needed urgent dental treatment, either the extraction or restoration of a tooth; this was provided at the hospital or arranged with the routine dental provider.
Twenty six of the 60 children studied had untreated dental caries, a potential source of infection and morbidity, and urgent treatment was required in 21 patients. The use and difficulties in gaining access to primary dental providers highlights deficiencies in the integration of medical and dental services. Preventing dental disease for this group of children is important because of the possible detrimental effect on their general health, and because treatment for their malignancy may affect development of dentition and function of oral tissues. Only three patients were taking fluoride supplements, the most effective caries preventive agent available, and one third of children reported brushing their teeth less than twice per day. Over half of the children or their parents asked about the effects of cancer treatment on the mouth, indicating a need for information about both the short and long term relation between oral health and cancer.
We have highlighted the need to improve integration of dental services into the medical care structure for patients with childhood malignancy. Collaboration with a specialist paediatric dental team at the oncology unit could achieve this objective. This study demonstrates the need for a dental screening programme and treatment facility to be available within a children’s hospital. Dental health information and advice should be provided and be easily accessible to patients, parents, the oncology team, and providers of primary dental care.