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Parent’s Guide to Dental Care for Children with Cancer

All children with a cancer diagnosis must get a dental check-up before the start of cancer treatment to make sure that cavities or other oral problems do not cause complications during cancer treatment.

Children with a history of cancer need to see a pediatric dentist regularly.

A child should have his/ her first dental visit no later than 12 months of age.

Children with cancer may develop problems in the mouth before, during and after cancer treatment.

Before cancer treatment begins children may have:

Swollen and/ or bleeding gums

Loose teeth

Ulcers in the mouth

Infections in the mouth

Changes in bone around teeth, seen on dental x-rays

Your child’s oncologist will request an oral health clearance from a dentist at the time of cancer diagnosis. The dentist your child usually sees can give a dental clearance.

During cancer treatment children may have some of these problems:

If your child has painful redness and/or ulcers in the mouth (mucositis), use a baking soda mouthwash (mix ¼ teaspoon of baking soda in 1 cup of lukewarm water and swish and spit, allow your child to suck on ice chips, and be sure to keep his mouth clean.

If your child has chapped lips, use a lanolin-based cream on his lips.

If your child has redness at the corners of his mouth (angular cheilitis), use a lanolin-based cream, petroleum jelly, or coconut oil.

If your child has a tightening of his jaw muscles (trismus), have him do some stretching exercises of the mouth.

Your child is more likely to get cavities during cancer treatment because of many reasons including having a dry mouth, medicines, pain and ulcers in the mouth, soft diet, etc.

Your child may also develop infections in the mouth during cancer treatment. This happens because your child’s immunity is low during cancer treatment and even normal bacteria, viruses, and fungus can easily cause infections. These infections may present as red or white patches, blisters, sores and/ or ulcers. If you notice any of these in your child’s mouth, let the doctor and the dentist know immediately.

Survivors of childhood cancers can have some of these problems:

Rough surface on permanent teeth (hypoplastic teeth):

These teeth are at high risk for cavities because bacteria are hard to clean from rough surfaces.

Short roots on permanent teeth:

Permanent teeth that were forming at the time your child received cancer treatment may develop short and blunted roots, instead of the usual length. This can make orthodontic treatment in the future difficult.

Small size of teeth:

Some permanent teeth may not grow as large as they should. This can lead to spacing between teeth.

Missing teeth:

Some permanent teeth may not form at all. This usually happens in children who have received radiation for cancer treatment.

Dry mouth:

The glands in and around the mouth that make spit may be damaged during cancer treatment. This can cause children to have less spit in their mouth (dry mouth) and make it more likely that they will get cavities.

Jaw pain:

Unexplained jaw pain and altered sensations (paresthesia) can develop as the child grows. This is more common in the lower jaw.

Decreased mouth opening:

The muscles around your child’s mouth may tighten and they won’t be able to open their mouth all the way. This makes brushing, flossing, and dental treatment difficult.

Questions to ask your child’s dentist:

My child just got diagnosed with cancer; what will you do today?

At this appointment, the dentist will do a thorough examination of your child’s mouth and teeth, to check for cavities, gum disease, and any other problems. The dentist may take X-rays of the teeth and jaw.

What if my child has cavities, and cancer treatment has not started?

Don’t worry. It is actually best to treat the cavities before starting cancer treatment. The dentist and the oncologist will work together to make sure the dental treatment is safely completed.

Will my child needs antibiotics for dental treatment?

Maybe. The oncologist will make this decision, based on your child’s blood counts and immune status. The dentist and the oncologist will work together to make sure you have the necessary prescriptions.

Will my child need a blood transfusion before dental treatment?

Maybe. The oncologist will make this recommendation based on your child’s blood counts. If your child’s platelets are low, he/ she may get a platelet transfusion, to help with clotting. This is important specially if teeth have to be taken out.

Should I brush my child’s teeth during cancer treatment?

Yes. Brushing during cancer treatment is very important to keep a clean mouth and prevent cavities as well as infections in the mouth. It may be difficult and painful to brush teeth if your child has ulcers or sores in his/her mouth during cancer treatment. Always use a soft-bristled toothbrush. You can also dip the toothbrush in hot water to soften the bristles and make brushing easier.

Should I floss my child’s teeth during cancer treatment?

Yes. Flossing cleans between teeth. It is important to use the dental floss in an upward and downward motion, making a C-shape around the tooth. Flossing in a sawing motion can cause damage to the gums.

Can my child have braces (orthodontic treatment) in the future?

Maybe. Braces increase the plaque build-up on teeth and increase the risk for developing cavities. If your child has teeth with short roots, then it is difficult to move these teeth with braces without causing more shortening of roots. Your child’s dentist will take these factors into consideration when making a recommendation for or against braces.

What will happen if my child gets a cavity during cancer treatment?

Don’t worry. The dentist and the oncologist will work together to find a time when it is best to do the dental treatment based on your child’s blood counts and response to cancer treatment. The dentist can also use some techniques to stop the cavity from getting bigger temporarily, so that the cavity can be treated as soon as your child’s oncologist clears your child for dental treatment.

Does my child need prescription fluoride products?

Maybe. The dentist may prescribe these based on the dental examination and x-rays. Some children who are at high risk for dental caries may be given a fluoride tray to wear on their teeth, if they can tolerate it.

What type of products can I use to help improve my child’s oral health?

Here are some options to discuss with your child’s dentist and find out what is best for your child:

For a dry mouth:

Drink plenty of water

Use alcohol-free mouth rinses like Biotene®/ Oasis® mouthwash

For gum disease:

Antibacterial mouthwash

Alcohol-free chlorhexidine mouthwash

To floss your child’s teeth:

Dental pick (supervise your child)

Gumchucks®

Water Flosser for Kids®

How can I prevent cavities and gum disease in my child?

Brush your child’s teeth every morning and night.

Use toothpaste with fluoride in it.

Floss after brushing at night. Flossing cleans between the teeth where the bristles of a toothbrush cannot reach.

Drink fluoridated water.

Stay away from foods that have added sugar. In-between meal snacks should not be sweet treats.

Do not drink juices, sodas, or sports drinks often.

Questions your child’s dentist might ask you:

Who are the doctors your child sees and how can I get in touch with them?

What medicines does your child take? What are the dosages? How does your child take the medicine (liquid, pills, injections)?

Has your child’s cancer treatment started? If not, when is it scheduled to start?

If your child has been treated for cancer in the past, and is now in remission, how often does your child see the oncologist for follow-up?

Does your child have any drug and food allergies?

Has your child taken their medicine(s) on time today?

Has your child ever needed to go to the emergency room?

What does your child eat for meals and snacks, and what do they drink?

Has your child had any complications or problems when having dental work done in the past?

Is your child afraid of the dentist?

What should you ask your child’s pediatrician?

Does my child need any extra protection while receiving dental care?

Is there anything the dentist should do differently for my child?

Does my child need antibiotics or transfusions before dental treatment?

When should my child see a dentist?

A child should see a dentist within 6 months of the first tooth coming in or by the first birthday- whichever happens first. But remember, it is never too late to start taking your child to the dentist.

How often should my child see the dentist?

Most children should see the dentist every 6 months. However, if your child is at high risk for dental caries, the dentist may recommend more frequent visits, such as every 3 or 4 month.

How to find a pediatric dentist:

American Academy of Pediatric Dentistry: www.aapd.org

American Board of Pediatric Dentistry: www.abpd.org

Additional Information on Childhood Cancer: https://medlineplus.gov/cancerinchildren.html

Note: The information you see describes general oral health information for children with cancer, but it does not apply to everyone. This information is not medical advice. Please contact a healthcare provider if your child has a medical problem. If you think your child may have a medical emergency, please call your child’s doctor or an emergency number immediately.

Text by Priyanshi Ritwik, DDS, MS

Edited by Julie Schiavo, MLIS, AHIP

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