Best clinical practise guidance for oral health care management of long-term childhood cancer survivors (CCS): an EAPD policy document.
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PURPOSE: The European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage the oral health of long-term childhood cancer survivors. METHODS: An expert group conducted a systematic review of the relevant literature on oral health care management of long-term childhood cancer survivors (CCS). The workshop was held during the corresponding EAPD interim seminar in Prague in May 2023. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified. RESULTS: The evidence regarding prevalence was limited to retrospective studies of moderate to good quality. Oral hygiene of CCS was worse compared to healthy individuals, showing higher values for gingival and plaque indices. Similarly, survivors had increased caries risk with higher mean dmft/DMFT and dt/DT values. The most common radiographic defects were impaired root growth in the permanent teeth and tooth agenesis. Enamel developmental defects, microdontia, and hypodontia were also commonly diagnosed. Age at start of treatment was identified as a risk factor, for the development of microdontia, tooth agenesis, and root defects in patients treated at age <3 years. The type of treatment also appeared to influence the risk, as an increased prevalence of dental caries and a higher frequency of root malformations were found in patients who had undergone concomitant radiation therapy, although evidence was limited. Treatment duration was not found to be a risk factor. CONCLUSION: These guidelines provide recommendations for dental management for childhood cancer survivors defined as children and adolescents up to the age of 19 years, regardless of age at initial diagnosis and treatment initiation.