Treatment for these and other childhood cancers may cause the late effect of problems with teeth and jaws:

• Head and neck cancers.
• Hodgkin lymphoma.
• Neuroblastoma.
• Leukemia that spreads to the brain and spinal cord.
• Nasopharyngeal cancer.
• Brain tumors.
• Cancers treated with total-body irradiation (TBI) as part of a stem cell transplant.

The risk of health problems that affect the teeth and jaws increases after treatment with the following:

• Radiation therapy to the head and neck.
• TBI as part of a stem cell transplant.
• Chemotherapy, especially with higher doses of alkylating agents such as cyclophosphamide.
• Surgery in the head and neck area.

Risk is also increased in survivors who were younger than 5 years at the time of treatment because their permanent teeth had not fully formed.

These and other signs and symptoms may be caused by late effects of the teeth and jaws or by other conditions:

• Teeth are small or do not have a normal shape.
• Missing permanent teeth.
• Permanent teeth come in at a later than normal age.
• Teeth have less enamel than normal.
• More tooth decay (cavities) and gum disease than normal.
• Dry mouth.
• Trouble chewing, swallowing, and speaking.
• Jaw pain.
• Jaws do not open and close the way they should.

Talk to your child's doctor if your child has any of these problems.

Teeth and jaws late effects and related health problems include the following:

• Teeth that are not normal.
• Tooth decay (including cavities) and gum disease.
• Salivary glands do not make enough saliva.
• Death of the bone cells in the jaw.
• Changes in the way the face, jaw, or skull form.

These and other tests and procedures may be used to diagnose late effects of the teeth and jaws:

• Dental exam and health history: An exam of the teeth, mouth, and jaws to check general signs of dental health, including checking for signs of disease, such as cavities or anything that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken. This may also be called a dental check-up.
• Panorex x-ray: An x-ray of all of the teeth and their roots. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• X-ray of the jaws: An x-ray of the jaws. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the head and neck, taken from different angles. The pictures are made by a computer linked to an x-ray machine. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the head and neck. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Biopsy: The removal of bone cells from the jaw so they can be viewed under a microscope to check for signs of bone death after radiation therapy.

Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of teeth and jaw late effects. If tests are needed, find out how often they should be done.

Doctors suggest that survivors of childhood cancer have a dental check-up and a cleaning and fluoride treatment every 6 months. Children who had radiation therapy to the oral cavity may also see an orthodontist or an otolaryngologist. If lesions are present in the mouth, a biopsy may be needed.