treatment. Major advances have been made in the treatment of childhood malignancy
in the last few decades, largely as a result of advances in chemotherapy and bone-
marrow transplantation.
Dental management of children with cancer
The children may have untreated caries and, since many are under 5 years of age, and
may not have had a previous dental examination. The oral side-effects of cancer
treatment are shown in 1110HTable 16.10 but can be categorized into (1) immediate and (2)
long term. The immediate problems include mucositis (oral ulceration) and
exacerbations of common oral diseases that may become life threatening and are
usually managed by paediatric dentistry specialists in liaison with their medical
colleagues. Child cancer survivors later present with long-term problems relating to: -
growth; puberty, and reproduction; cardiac; thyroid; cognitive deficit; and social
function. Oral and dental development can also be impeded and specialist advice
might again be required. Despite this, the introduction of a shared care arrangement
between the primary dental practitioner and the paediatric specialist when the child is
in remission is vital to ensure continued preventive therapy and good oral health while
at the same time 'normalizing' care.
Key Points
- Children with cancer need the combined care of primary and specialist dental
services; - There are immediate and long-term effects of cancer treatment;
- Disease prevention is vital.
16.8 ORGAN TRANSPLANTATION
16.8.0 Introduction
Kidney, heart, bone marrow, liver, and pancreas transplantation are now routine
procedures. Most liver transplants in children occur because of biliary atresia. Bone
marrow transplants are the treatment of choice for children with aplastic anaemia,
those who fail conventional therapy for leukaemia, and for some immune deficiency
disorders. Although children with end-stage renal disease can be kept alive by
haemodialysis, their quality of life is considerably improved by kidney
transplantation. Children who require organ transplantation are considered to be at a
high caries risk and so prevention is important.
16.8.1 Pretransplant treatment planning
Any candidate for organ transplantation should be referred for specialist dental
evaluation. Whenever possible, active dental disease should be treated before the
transplant procedure and any teeth with doubtful prognoses extracted. This may
present difficulties as many pretransplant patients can be seriously ill and have
various associated medical problems. Moreover, some children will be placed on a
high carbohydrate (cariogenic) diet, for example, 'maxijul', to 'build-them-up' in
preparation for surgery and so the dental team will need to adopt a pragmatic
approach to advice relating to sugar intake and frequency during this time, since the
child's medical well being must take priority. Children undergoing bone marrow