Mouth Care and Oral Health

It is important to take good care of your child’s mouth and watch for problems that might develop. Mouth problems, such as painful sores, dry mouth, cracked lips, and tooth problems are common in children with cancer and other illnesses. Keeping the mouth clean helps reduce bacteria that lead to tooth decay. Bacteria in the mouth can also travel through the bloodstream and cause infection. 

A mouth care routine helps your child’s oral health, now and in the future. Mouth care can include:

• Brushing teeth
• Rinsing the mouth
• Using lip balm
• Using dental floss if recommended by your care team
• Preventing dry mouth
• Checking the teeth, gums, and mouth for problems
• Cold therapy during chemotherapy to help prevent mouth sores
• Regular dentist visits

Be sure to practice mouth care even if your child has a feeding tube or does not eat by mouth. Your care team may give special mouth care instructions if your child has mouth sores, is getting certain treatments, has low blood counts, or has had a bone marrow (stem cell) transplant.

Use a soft toothbrush to brush teeth and tongue at least 2 times per day. Always brush after having sweets or sugary foods or drinks.

• Use fluoride toothpaste with the American Dental Association (ADA) seal of approval.
• If your child is under age 6, use a pea-size amount.
• If your child is under age 3, use an amount about the size of a grain of rice.
• Make sure your child does not swallow toothpaste. Have them spit out any extra toothpaste but do not rinse after brushing. Rinsing can wash away the fluoride that helps prevent cavities.
• Use a soft toothbrush. Stand it up and let it dry completely after each use.
• Help children under age 8 to make sure they brush well.
  
• If it isn’t possible to use a toothbrush, clean teeth with a piece of moist gauze wrapped around 1 finger. You can also use a small sponge or a foam toothbrush. Ask your care team for help with these items.
• Replace the toothbrush every 2 months or sooner if the bristles wear down.
• If your child has an infection, use a new toothbrush. When the infection is gone, use another new toothbrush. 

Use a mouth rinse

Mouth rinses can help clean the mouth and treat problems like dry mouth or mouth sores. Use mouthwashes or mouth rinses prescribed by your care team.

Rinse your child’s mouth with 5 to 10 milliliters (mL) of a mouth rinse at least 3 times each day. Mouth rinses include Biotene®, alkaline saline, and Cepacol®.

Floss teeth as recommended

Floss daily unless the care team tells you not to. Unless your child has mouth sores or low blood counts, flossing is usually recommended. Check with your care team if you aren’t sure.

Use lip balm

The skin on the lips is thin and delicate. It is easy for your child’s lips to become dry, chapped, or cracked.

Put a lip balm, ointment, or cream with lanolin on your child’s lips at least twice a day. Also, apply lip balm as needed when lips are dry. Choose a lip balm or ointment that is fragrance free and safe for sensitive skin.

Do not let your child pick at peeling skin. This can create sores or lead to infection. Licking the lips can also make chapped lips worse.

Prevent dry mouth

Dry mouth occurs when there is too little saliva or saliva is too thick. This can happen if your child is dehydrated. It can also be a side effect of chemotherapy, medicines, or radiation therapy. Patients who have a tube to help them breathe (intubation) or who have a feeding tube are also at higher risk for dry mouth.

Dry mouth can cause problems such as sore throat, trouble speaking or swallowing, hoarseness, and bad breath, Saliva helps protect teeth by washing away food, bacteria, and acids. Over time, dry mouth can lead to tooth decay.

Ways your child can help prevent or manage dry mouth include:

• Chew sugar-free gum or suck on sugar-free candies. Make sure your child can have these safely.
• Sip water or let ice chips melt in your child’s mouth.
• Breathe through the nose instead of the mouth.
• Limit caffeine intake.
• Use a saliva substitute or mouth rinse as recommended by your health care provider.

Check for mouth sores

Your child’s mouth care routine should include checking for sores on the lips, gums, tongue, cheeks, under the tongue, and the roof of the mouth. Mouth sores are caused by many health conditions and are a common side effect of chemotherapy. Mouth sores can be painful, increase risk of infection, and make it hard to swallow, eat, and drink.

If your child gets mouth sores, a nurse may give your child a mouthwash, gel, or spray to make the sores hurt less. Your child might also take medicine to help the pain or stop an infection.

Read more about mouth sores and cancer treatment.

Reminders for oral health

Good oral health starts with daily mouth care.

Here are some other things you can do for a healthier mouth and teeth:

• Get regular dental exams. Make sure the dentist knows your medical history.
• Drink water with fluoride. Limit sweetened drinks like sodas and sports drinks.
• Eat healthy foods low in sugar.
• If you vomit, rinse out your mouth with water. Brush your teeth, if possible. Acid from the stomach can harm teeth.
• Don’t share feeding utensils or other items such as pacifiers or teething toys. Bacteria from saliva can be passed from person to person.
• Do not get mouth piercings. Mouth piercings increase the risk of infection and can damage teeth and gums.
• Don’t smoke or use other tobacco products.
• See a dentist if you have concerns about oral health. Common problems include bite issues, tooth crowding, cavities, discoloration of teeth, bleeding gums, or teeth not coming in on schedule.

Find more information at the ADA's Mouth Healthy website.