Supportive Care in Cancer

, Volume 22, Issue 7, pp 2009–2019

Oral and dental late effects in survivors of childhood cancer: a Children’s Oncology Group report

  • Karen E. Effinger
  • Cesar A. Migliorati
  • Melissa M. Hudson
  • Kevin P. McMullen
  • Sue C. Kaste
  • Kathy Ruble
  • Gregory M. T. Guilcher
  • Ami J. Shah
  • Sharon M. Castellino
Review Article



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.


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.


The Children’s Oncology Group oral-dental panel 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. Additionally, head and neck radiation and hematopoietic stem cell transplantation increase the risk of subsequent malignant neoplasms in the oral cavity. Survivors require routine dental care to evaluate for potential side effects and initiate early treatment.


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.


Pediatric cancer Oral dental health Survivorship Late effects 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Karen E. Effinger
    • 1
  • Cesar A. Migliorati
    • 2
  • Melissa M. Hudson
    • 3
  • Kevin P. McMullen
    • 4
  • Sue C. Kaste
    • 5
  • Kathy Ruble
    • 6
  • Gregory M. T. Guilcher
    • 7
  • Ami J. Shah
    • 8
  • Sharon M. Castellino
    • 9
  1. 1.Division of Pediatric Hematology/Oncology/Stem Cell TransplantationStanford UniversityPalo AltoUSA
  2. 2.Department of Diagnostic Sciences and Oral MedicineUniversity of Tennessee Health Science CenterMemphisUSA
  3. 3.Departments of Oncology and Epidemiology and Cancer ControlSt. Jude Children’s Research HospitalMemphisUSA
  4. 4.Department of Radiation OncologyIndiana University School of MedicineIndianapolisUSA
  5. 5.Department of Radiological SciencesSt. Jude Children’s Research HospitalMemphisUSA
  6. 6.Division of Pediatric Oncology, John Hopkins School of MedicineBloomberg Children’s CenterBaltimoreUSA
  7. 7.Section of Paediatric Oncology, Division of OncologyUniversity of CalgaryCalgaryCanada
  8. 8.Division of Pediatric Hematology/OncologyUniversity of California Los AngelesLos AngelesUSA
  9. 9.Departments of Pediatrics, Section of Hematology/Oncology, and EpidemiologyWake Forest University School of MedicineWinston-SalemUSA

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