CDHA Recognizes Children's Cancer Awareness Month

Posted on September 4, 2015


All of us know someone who has been affected by cancer. Unfortunately, the sad truth is that our most vulnerable population, our children, can also be the victims of cancer. In the U.S., 15,780 children under the age of 21 are diagnosed each year with cancer, according to the American Childhood Cancer Organization (ACCO).

There are many types of childhood cancers that range from brain cancer to lymphomas and sarcomas. Treating a child with cancer involves a large team of specialists and oncologists. “Because there is a risk of developing side effects which are linked to dental disease, seeing a dentist and/or dental hygienist before cancer treatment begins is imperative," states California Dental Hygienists’ Association (CDHA) President Lygia Jolley, RDH, BA. Both the disease and the treatment can cause many problems that affect the child’s mouth. Among these are dry mouth (xerostomia), mouth sores (mucositis), tooth decay, difficulty swallowing (dysphagia), difficulty chewing or opening the mouth (trismus), oral infections, bone disease, inflammation or pain in the lining of the mouth and tongue.


According to the American Cancer Society , the types of cancer treatments which have proven to be the most beneficial and effective include chemotherapy, radiation therapy, and the new technique of plasma laser surgery.

Chemotherapy is a cocktail of drugs given intravenously to kill the rapidly growing cancer cells. Plasma Laser surgery uses focused lasers directed at the affected cells to destroy them. And radiation therapy is delivered directly to the tumor to kill the cancerous cells. Unfortunately, all three treatment options do damage or produce side effects that can affect the patient. The acute concerns of cancer treatment relate to the child’s immediate overall health, while the chronic effects can have implications regarding the growth of the child.

Oral Considerations

“Dental treatment is an extremely important need before beginning cancer treatment,” states Jolley. "It identifies existing risk factors, oral treatment needs, and oral hygiene care recommendations,” continues Jolley. An appropriate amount of time needs to be considered for oral care before starting cancer treatment. To start, the child needs to visit a dentist and hygienist for evaluations, ideally one month before cancer treatment begins to allow enough time for the tissue to heal following any dental treatment needs. During this phase, the dentist should take a panoramic and full mouth x-rays to look for any abnormalities such as periodontal disease, ongoing infections, or cavities. Additionally, the dentist or hygienist will conduct an oral cancer screening to check for signs cancer that may be present in the mouth. Orthodontic braces also need to be removed, and extraction of any loose and hopeless teeth should also be accomplished at this time.

Cancer treatment related dental education for the child and parents is key for good oral health during the child’s treatment. Overall, good brushing and flossing is imperative. The child’s immune system is compromised during treatment, so extra attention to daily cleanings to keep the mouth clean goes a long way. At the first sign of any oral complications related to cancer treatment, the child should be immediately seen by a dentist or hygienist. Be sure to alert your dental provider to the types of cancer treatment the child is undergoing. Often times, blood work is needed 24 hours prior to care so that the clotting factors and immune system mediators are measured. Additionally, antibiotics may be needed to prevent infections following dental hygiene care. The CDHA suggests the following care tips:

Gently brush your teeth two times a day, and floss regularly. It is important to continue good oral hygiene practices. If the gums are sore, it may also help to soak an extra-soft toothbrush in warm water to soften the bristles before brushing. Prescription rinses are available to relieve oral pain associated with chemo and radiation therapy.

Avoid alcohol based mouth rinses and extremes in your diet. Do not rinse with an alcohol based mouth rinse - choose an alcohol free mouth rinse instead. Food choices should include foods that are soft and mild. Extremely hot, cold, spicy, acidic, or crunchy foods may irritate your mouth and cause damage.

Promote good bone health. Getting enough vitamin D and calcium each day helps promote a strong, healthy jaw and teeth. Dairy products are good sources of calcium and, if fortified, vitamin D. Other food choices may include fortified fruit juice and fortified breakfast cereals. Talk with your doctor before taking any supplements.

Drinking water and sugarless drinks may help manage dry mouth. Sucking on ice chips or using candy sweetened only with Xylitol is a good alternative. Try to avoid things that will dry out your mouth and cause cavities, such as sodas and fruit juice. Topical oral gels or rinses can be prescribed for dry mouth either caused by chemotherapy or radiation therapy to the head and neck.


In some cases, the child cannot go to a dentist for checkups and dental hygiene care. In this case, a Registered Dental Hygienist in Alternative Practice (RDHAP) can be the best option. RDHAPs are licensed hygienists who can work in hospitals, home care facilities, and can travel to the sick patient’s home to provide dental hygiene care. RDHAPs do not need a dentist present to provide dental hygiene care. They are able to do oral screening, place sealants, and clean a patient’s teeth without having them leave the bed or his/her comfort place. To find an RDHAP, visit

Following Successful Cancer Treatment

It is important to receive ongoing dental examinations following cancer treatments, as after after effects can be far reaching.

Children who have been under chemotherapy before their permanent teeth were fully formed, especially if they were younger than five years old at the time of treatment, are at greater risk of future dental problems. In addition, radiation therapy near or in the mouth will affect the salivary glands and may cause permanent loss of salivary function. This may lead to a life long increased risk for dental decay and periodontal disease. Radiation therapy can also cause unintended nerve damage creating taste alteration which can lead to disruptions in diet.

Chemotherapy affects bone density by decreasing the level of calcium in the body. As a result, the growing child can develop TMJ problems, locking of the jaw, asymmetrical growth of face and jaw bone, abnormally sized/shaped teeth, or severe orthodontic complications.

It is very important to consult with your doctors and dental care team regarding any questions or concerns before, during, and after any cancer treatment of your child.

The CDHA recommends visiting its website for more information:

The California Dental Hygienists’ Association (CDHA) is the authoritative voice of the state’s dental hygiene profession. The organization was established 30 years ago when two regional associations merged to form a unified professional group. CDHA represents thousands of dental hygienists.

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