Mouth Care

Introduction

Despite significant advances in chemotherapy, radiotherapy and immunotherapy, cancer treatments can often result in clinically important and sometimes dose-limiting side effects. These include mucositis, candidiasis and other fungal infections, salivary gland damage, and reactivation of herpes virus. Oral complications during and after treatment are common, frequently leading to pain, difficulty in swallowing, impaired speech, and nutritional challenges. Collectively, these issues can profoundly impact a patient’s quality of life (Heggie et al, 2024).

In paediatric haematology and oncology, mouth care is therefore a critical component of overall management. The primary objective is to maintain the child’s oral cavity in a state that is clean, moist, and free from infection. Consistent and thorough oral care is essential for all children, regardless of whether they are eating, as it helps prevent complications and supports comfort. While many children experience relatively few oral problems during therapy, the underlying diagnosis and the intensity of treatment can largely determine the level of oral care and intervention required.

Page contents

On this page you will find information about:

Introduction
9.1 Basic Principles of Oral Hygiene
9.2 Oral Care
9.3 Management of Oral Mucositis:
References:

9.1 Basic Principles of Oral Hygiene

Maintain the oral mucosa in a clean, soft, moist, and intact state.
Keep the lips clean, hydrated, smooth, and intact.
Remove food particles and dental plaque gently, without causing gum injury.
Relieve pain or discomfort within the mouth.
Prevent bad breath and promote a fresh oral environment.
Reduce the risk of oral and systemic infections.
Promote overall comfort and well-being.

(Health Service Executive, 2022)

9.2 Oral Care

At Diagnosis:

If invasive dental treatment is required at the time of cancer diagnosis this should be undertaken by a Paediatric Dentist.
Any child who might potentially need Haemopoietic Stem Cell Transplant (HSCT) should have a dental assessment by a Paediatric Dentist at diagnosis in order to prevent significant dental disease which might compromise HSCT.
Education should be provided to the family before treatment starts.

During Treatment:

Children should brush their teeth twice daily with fluoride toothpaste.
A soft brush should be used if the mouth is sore.
Powered toothbrush can remove more plaque and reduce gingivitis but they are not advisable for children with a fragile mucosa.
Toothbrushes should be replaces every 3 months, after an infection or if the bristles are damaged.
For babies or children who are unable to brush, dampened oral sponges can be used. They must be supervised at all times due to risk of detachment presenting a choking hazard (Medicines and Healthcare Products Regulatory Agency, 2012).
If the baby or child has a dummy, they must be changed frequently and/or after a mouth infection. They must be sterilised frequently.
The dental team should be notified of any oral problems arising during cancer treatment and the cancer team should be informed of the type and extent of dental treatment required.
Assessing the oral cavity involves a thorough and systematic approach. This is essential so that any changes are monitored and appropriate treatment implemented.
For a child with oral complications, an appropriate pain assessment should be undertaken to ensure adequate pain control and therapeutic interventions are available.

(The Children’s & Young People Cancer Association, 2025; Dental Health Foundation, 2024a; Dental Health Foundation Ireland, 2024b; UKCCSG-PONF Mouth Care Group, 2006)

After Treatment:

Parents and children should be informed of the possible long-term dental effects of childhood cancer and treatment.
The routine dental care provider in the general or community dental service should be notified of the cancer diagnosis and arrangements should be made for regular care after cancer treatment.
Children should be referred back to their routine dental provider, who should be notified of the cancer diagnosis and any other relevant information regarding their oral health.

9.3 Management of Oral Mucositis:

Both bacteriology and virology mouth swabs should be taken
Consult with the paediatric oncology department and under guidance, the following may be recommended:
Regular pain relief, refer to section …………….
- Difflam mouthwash or spray for analgesia, but consider the appropriateness for child.
- Gelclair
- Omeprazole for epigastric pain
Fluid balance should be carefully monitored.
TPN and NCA/PCA may need to be considered for severe mucositis.

(The Children’s & Young People Cancer Association, 2025)

References:

Dental Health Foundation (2024a). Children’s oral health 2-12 years, Dental Health Foundation. Available at: https://www.dentalhealth.ie/children-oral-health/children/. (Accessed: 19 September 2025).

Dental Health Foundation Ireland (2024b). Oral Health in Ireland, 3rd edition. Available at: https://www.dentalhealth.ie/assets/files/pdf/oral_health_in_ireland_third_edition_web.pdf. (Accessed: 19th September 2025).

Health Service Executive (HSE) (2022) Looking after your child’s teeth, HSE.IE. Available at: https://www2.hse.ie/babies-children/parenting-advice/caring-for-a-child/looking-after-your-childs-teeth/ (Accessed: 19 September 2025).

Heggie, C. et al. (2024). ‘It’s like being chained up’: The oral mucositis experiences of children and young people with cancer, their parents, and healthcare professionals– a qualitative study’, Archives of Disease in Childhood, 110(4), pp. 287–294. doi:10.1136/archdischild-2024-327529.

Medicines and Healthcare Products Regulatory Agency (2012) Oral swabs with a foam head - heads may detach during use, GOV.UK. Available at: https://www.gov.uk/drug-device-alerts/medical-device-alert-oral-swabs-with-a-foam-head-heads-may-detach-during-use (Accessed: 19 September 2025).

The Children’s & Young People Cancer Association (2025). Mucositis and Mouth Care, CCLG. Available at: https://www.cclg.org.uk/information-professionals/outreach-information-resource/section-7-side-effects-and-supportive-care/mucositis-and-mouth-care. (Accessed: 18 September 2025).

UKCCSG-PONF Mouth Care Group (2006). Mouth care for children and young people with cancer: evidence-based guidelines. Available at: [PDF] Mouth Care for Children and Young People with Cancer: Evidence-based Guidelines. Guideline Report - Free Download PDF. (Accessed: 18th September 2025).