Mouth Care and Oral Health

It is important to take good care of your child’s mouth and watch for problems. Mouth problems such as sores, dry mouth, cracked lips, and tooth decay are common in children with cancer and other illnesses.  

Keeping the mouth clean helps reduce bacteria that can lead to tooth decay (cavities). Bacteria in the mouth can also travel through the bloodstream and cause infection.  

A daily 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 
• Flossing  
• Preventing dry mouth 
• Checking the mouth for sores 
• Using cold therapy or light therapy during chemotherapy   
• Getting regular dental exams 

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

Brush teeth at least 2 times each day

Use a soft toothbrush to brush your child’s teeth and tongue at least 2 times each day. Brush after having sweets or sugary drinks. 

An adult should help or watch brushing to be sure the right amount of toothpaste is used and that all teeth are cleaned well until about 8-10 years of age.  

• Use a fluoride toothpaste that has the American Dental Association (ADA) Seal of Acceptance.
• Use the right amount of toothpaste for your child’s age: 
  • For children under age 3, use a grain-of-rice amount. 
  • For children ages 3 to 6, use a pea‑sized amount. 
  • For children older than 6, use a strip of toothpaste that covers about half of the toothbrush bristles. 
• Make sure your child does not swallow toothpaste. They should spit it out. Do not rinse after brushing. Rinsing can wash away the fluoride that helps prevent cavities. 
• Rinse the toothbrush and let it dry upright after each use. 
• Replace the toothbrush every 2 months or more often if the bristles wear down. 
• Use a new toothbrush if your child has an infection. When the infection is gone, use another new toothbrush.  
• If you cannot brush your child’s teeth with a toothbrush, use moist gauze, a small sponge, or a foam toothbrush. Ask your care team for help with these items. 

Use a mouth rinse

A mouth rinse can help clean the mouth. It can also help manage dry mouth and mouth sores. Use the mouth rinse your care team prescribes or recommends. 

Rinse with 5 to 10 milliliters (mL) of a mouth rinse at least 3 times each day.  

Do not give mouth rinse to children younger than age 6 years. If your older child uses a rinse, make sure they spit it out and do not swallow it. Keep mouth rinses out of the reach of children. 

Floss teeth as recommended

Floss 1 time each day unless your care team tells you not to. Flossing is usually recommended unless your child has mouth sores or a low blood count. Check with your care team if you are not sure. 

Start flossing when your child’s teeth are close together and do not have space between them.  

Use lip balm

The skin on the lips is thin and delicate. It is easy for lips to become dry, chapped, and cracked. 

Put a fragrance-free lip balm, ointment, or cream with lanolin on your child’s lips at least 2 times each day. Apply more often as needed. Use something safe for sensitive skin. 

Do not let your child lick or pick at peeling skin. This can worsen chapped lips, cause sores, or lead to infection. 

Prevent dry mouth

Dry mouth happens when there is not enough saliva (spit) or the 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 with a breathing tube or feeding tube may get dry mouth. 

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

Ways to help prevent or manage dry mouth include: 

• Chew sugar-free gum or suck on sugar-free candies if it is safe for your child. 
• Sip water or let ice chips melt in your child’s mouth. 
• Have your child breathe through their nose instead of their mouth. 
• Limit caffeine intake. 
• Use a saliva substitute or mouth rinse as recommended by your care team. 

Check for mouth sores

Include a quick check for sores in your child’s routine. Look at the lips, gums, tongue, cheeks, under the tongue, and the roof of the mouth. Mouth sores are a common side effect of chemotherapy. They can be painful, increase the risk of infection, and make it hard to swallow, eat, and drink. 

If sores occur, your child may get a mouth rinse, gel, or spray to reduce pain. Your health care provider may prescribe medicine for pain or infection.   

If your child gets chemotherapy, your care team may have your child eat ice chips during treatment to reduce mouth sores. They may also use red light therapy to prevent or treat mouth sores. 

Get regular dental exams

Regular dental exams help keep your child’s mouth healthy. They also help dentists find and treat problems early, before they are serious. Many dentists suggest a checkup every 6 months. 

When to start 

Your child’s first dental visit should be when they get their first tooth or have their first birthday. Early visits help your child get used to the dentist. They also give the care team time to talk with you about brushing, fluoride treatments, and healthy habits. 

Choose the right provider 

A pediatric dentist is trained to care for infants, children, and teens, including those with special needs. If you cannot visit a pediatric dentist, your child can also get care from a general dentist who treats children. 

Before each visit 

• Share your child’s health history, current medicines, and any upcoming or recent treatments. 
• Ask about when your child needs checkups, x‑rays, and fluoride treatments. 
• Tell the dentist if your child is at risk for dry mouth or mouth sores. 

Reminders for oral health

Good oral health starts with daily mouth care. Other healthy habits include: 

• Drink water with fluoride. Most tap water has fluoride, but bottled water may not.  
• Limit sweet drinks like soda, juice, and sports drinks. If your child has sweets or sweet drinks, give them with a meal, not between meals. Avoid sipping or snacking on sweet foods or drinks throughout the day, as this can cause tooth decay. 
• Eat healthy foods low in sugar. 
• If your child vomits, rinse their mouth with water. Brush their teeth if you can. Stomach acid can harm teeth. 
• Do not share spoons, forks, pacifiers, or teething toys. Bacteria from saliva can pass from person to person. 
• Do not get mouth piercings. They can increase the risk of infection and damage teeth and gums. 
• Do not smoke or use other tobacco products. 
• See a dentist if you notice dental problems, such as bite issues, tooth crowding, cavities, teeth that look lighter or darker than usual, bleeding gums, or teeth not coming in when they should. 

Questions to ask your care team 

• How often should my child see the dentist? 
• How do I find a pediatric dentist?  
• When can kids brush their own teeth?  
• What mouth care steps are most important for my child during treatment?  
• Does my child need to change brushing, flossing, or rinsing because of medicines, low counts, or mouth sores?  
• What can we use safely for dry mouth or mouth pain at home? 
• What warning signs mean we need to call the care team or dentist right away? 

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