Mouth care
Daily care
Children should brush their teeth and gums with fluoride toothpaste and a soft bristle toothbrush every morning and night. You may need to help your child do this. When the toothbrush bristles get stiff or bent, you should replace your child’s toothbrush about every three months.
Use dental floss only if you are familiar with the procedure. Check with your doctor or nurse for the times when it is OK to floss.
If your child’s mouth feels dry, he or she can rinse with salt water solution of ¼ teaspoon salt mixed in one glass of lukewarm water. Do not use drugstore mouthwash. Avoid all mouthwash with alcohol, since it dries the mouth.
For dry lips, use a lanolin ointment or Nature’s Second Skin® to moisten, not Vaseline.
To lessen the mouth sores, which may occur during chemotherapy or radiation therapy, have your child rinse with Peridex® after each morning and evening brushing. One to two teaspoons are swished in the mouth for 30 seconds then spit out. Peridex® can change the way food tastes. Ask you doctor or dentist about Peridex®.
After your child brushes his or her teeth, examine the mouth area. Your hands should be clean when you do this. Look for these things:
• Lips should be smooth and moist.
• Tongue should be moist, smooth and pink with no coating.
• Floor of the mouth should be moist and pink.
• Open the mouth as wide as possible. Check the roof of the mouth and sides of the cheeks; they should be moist, pink and free of spots or patches.
• Teeth should be white and free of film, soft debris or crusts.
This exam is an important part of daily care. If you see red or white spots or patches, sores, or if your child’s tongue looks furry or coated, call your doctor or nurse coordinator.
Your child needs to brush his or her teeth after eating sweets. If a brush is not available, help your child swish and swallow with lukewarm water three to four times. Try to avoid frequent sweet snacks, especially sticky or chewy candy, raisins, fruit rolls and hard candies. Snacks that are less likely to cause cavities include cheese, carrots, fresh fruit, popcorn, crackers, pretzels, chips, and artificially sweetened candy, gum and sodas.
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nursing notes
Toddlers and preschoolers
When the first tooth is visible, begin cleaning your child’s teeth and gums after each feeding. Clean using a water-moistened gauze wrapped around your finger. Examine your child’s mouth at this time. As soon as your child has several baby teeth, you should brush your child’s teeth two times a day.
If your child tends to swallow toothpaste, do not use it. Use plain water instead.
After your child takes sweetened medicine (liquid or pill), help your child rinse his or her mouth with water.
If your child takes a bottle to bed, fill it only with water. Do not send your child to bed with formula, juice or milk, since this can cause tooth decay. If your child cries, try giving him or her a clean pacifier instead of a bottle.
nursing notes
Mild mouth irritation
The dentist or doctor needs to examine your child’s mouth. The following are signs of a mild mouth irritation:
• Red, shiny gums and mouth lining that can include white patches
• Gums look swollen
• A burning feeling or tenderness in the mouth, but no sores can be seen
• Tongue may be coated, red, dry or swollen
The dentist or doctor will ask you to help your child:
• Eat bland foods, such as mashed potatoes or fruit-flavored gelatin. Avoid acidic, fried or hard crusty foods that may irritate your child’s mouth.
• Rinse with salt-soda solution as often as every two hours when awake. You can make your own solution, using this recipe:
~ 1/2 teaspoon salt
~ 1/4 teaspoon soda
~ 8 ounces water
• Twice a day: If dried mucus or food is present, rinse the mouth first with 1 tablespoon of Peroxyl® mixed with 1 tablespoon lukewarm water, or use a soft toothbrush dipped in Peroxyl®. Then rinse the mouth well with the salt-soda solution or plain water.
*DO NOT use Peroxyl® as a mouth rinse more than three days in a row.
• Remove a coating on the tongue by brushing or scraping this area twice a day. Scraping may be done with a tongue blade, plastic spoon or special “scraper.” Then rinse mouth well with the salt-soda solution or plain water.
Nursing Notes
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• Relieve mouth pain by swishing 1 teaspoon ST-37 solution mixed with 1 teaspoon plain water for 1 minute, then spit it out. Your child should do this 15 minutes before eating and as needed.
Moderate mouth sores
The dentist or doctor needs to examine your child’s mouth. With moderate mouth sores your child will have pain in these areas during eating and swallowing.
The dentist or your doctor will ask you to help your child:
• Eat bland foods, such as mashed potatoes or fruit-flavored gelatin.
• Clean teeth and gums using a soft toothbrush. Dip the toothbrush in a mixture of 1 tablespoon Peroxyl® mixed with 1 tablespoon of plain water. Then your child can rinse with a large mouthful of salt-soda solution. If the Peroxyl® causes a burning feeling in the mouth, increase the amount of lukewarm water.
You can decrease your child’s mouth pain, depending on the amount of sores, by doing the following:
• For a few tiny sores, place KANKA® solution on a cotton swab and touch the sore mouth areas. Your child may complain of a burning feeling for a few seconds, but then the pain should get better. Help your child with this treatment three times a day.
• For many or large mouth sores, help your child swish and spit 1 to 2 teaspoons of Ulcer-Ease® solution in the mouth. Your child should hold the solution in his or her mouth for 30 seconds or longer before spitting it out. Help your child with this treatment four times a day.
nursing notes
Dry mouth
• Rinse with salt-soda solution every two hours or as needed. You can find a recipe for making your own solution under “Mild mouth irritation.”
• Moist foods like fruit-flavored gelatin, gravy or a sauce will help swallowing.
• Artificial saliva may be ordered by the dentist or doctor or Moi-Stir® swabsticks may be used several times a day.
• Moisten lips with lanolin ointment. One brand name for this ointment is Nature’s Second Skin®.
• Chew sugar-free gum.
Nursing notes
Dry, cracked, crusty lips
Clean every two hours with a clean washcloth soaked with salt-soda solution. Pat dry with another clean cloth and apply lanolin ointment. Do not use petroleum jelly or lip balms, because they can dry out the lips even more.
Nursing notes
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Low platelet count
• Gently brush teeth and gums with a soft toothbrush. Dip the toothbrush in a solution of 1 tablespoon Peroxyl® mixed with 5 tablespoons of water. You may also use a moist washcloth wrapped around a finger.
• Rinse with the salt-soda solution.
• If your child has cracking at the corners of his or her mouth, it could mean that your child has a yeast infection. Ask your doctor or nurse coordinator about a special ointment you can use.
If you have any questions or concerns, please speak with your child’s doctor or nurse coordinator.
nursing notes
Adapted with permission from St. Jude Children’s Research Hospital. Revised 9/03
UC Davis Cancer Center 12/06
www.ucdmc.ucdavis.edu/cancer
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