Mouth care for children receiving chemotherapy or undergoing blood/marrow transplant

Cells in the mouth can be affected by chemotherapy and radiation to the head and neck area. To avoid infection, your child needs to maintain good oral hygiene all though the course of treatment.

Good oral care will help to:

• reduce mouth pain and bleeding related to cancer therapy
  
• prevent infection, which may affect the entire body
  
• reduce the risk of future dental problems, such as cavities and gingivitis
  

Assessment by a dentist

Your child should be seen by a dentist at the hospital before or soon after the start of treatment. At this visit, the dentist will:

• identify current or potential sources of infection
  
• reduce or get rid of any sources of infection; for example, if your child has braces or other appliances, the dentist may recommend removing them
  
• review proper brushing technique with you and your child
  
• tell you if your child should floss
  
• discuss behaviours that influence oral health
  
• advise you about other measures you can take to prevent infection
• coordinate with your doctor to determine the best time for dental treatment if your child's teeth have cavities and/or infection
  

Together, you and the dentist will create a plan that will best meet your child's oral health needs.

Ideally, your child should see a dentist every three to six months during active cancer treatment. This can be a dentist at the hospital or your child's regular (community) dentist. Your team will help you decide the best place for ongoing care.

Once treatment is finished, your child should be seen on a regular basis by your community dentist.

Mouth care technique

Your child should:

• Brush their teeth and tongue two or three times each day with a regular soft toothbrush and fluoride toothpaste.
• Use dental floss, if the dentist says so.

For more information about how best to brush your child's teeth, please see Cleaning teeth, a resource from the Canadian Dental Association.

If your child's gums bleed or your child's mouth is sore

If your child's gums bleed when they brush, or if their mouth is too sore to brush, your child should use a sodium bicarbonate (baking soda) mouthwash in place of toothpaste and toothbrush. You can easily make this mouthwash at home.

• Your child should swish and spit 5 to 15 mL (1 to 3 teaspoons) of the baking soda mouthwash two or three times each day.
• Children who cannot spit out the mouthwash should swish and swallow with water instead.
• If your child cannot swish and spit, you can wrap your finger in a clean, damp cloth and gently clean your child's teeth and mouth.
• When your child's mouth is comfortable again, your child should go back to regular brushing and flossing.

Do not use mouthwashes that contain alcohol, as they can make your child's sore mouth worse.

Long-term outcomes

Cancer treatment may have long-term effects on teeth development and the risk of dental caries (cavities). Please speak to your dentist about these effects and how to prevent or manage them.

At SickKids

These guidelines outline the recommended basic mouth care for children receiving chemotherapy or blood/marrow transplant (BMT) at The Hospital for Sick Children (SickKids).

It is very important to monitor your child's oral health once they are diagnosed with cancer. The dental team and your doctor at SickKids will coordinate any necessary treatment and make sure your child has optimal oral health during cancer treatment.