Oral and Dental Health in Children with Leukemia: Care During and After Treatment

November 2–8 Children with Leukemia Week

Oral health is important for a child undergoing leukemia treatment to be able to eat, drink water and speak comfortably. Oral and dental care aims not only to prevent cavities but also to reduce problems related to pain, mouth sores and infections.

As Dental Estetik Center, during the November 2–8 Children with Leukemia Week, we draw attention to protecting children's oral and dental health during and after treatment. Leukemia is not contagious. Children need accurate information, safe care and social support.

How do leukemia and its treatment affect oral health?

The disease and the treatments applied can affect blood cells and oral tissues. A decrease in the cells that fight infections increases the importance of infections in the mouth. Low levels of platelets, which play a role in blood clotting, can lead to gum bleeding. These symptoms alone do not lead to a diagnosis of leukemia.

During chemotherapy, oral mucositis, which involves redness, sensitivity and sores inside the mouth, may develop. Dry mouth, changes in taste and difficulty swallowing can also make eating difficult. Early communication with the treatment team is needed to reduce pain and maintain oral care.

Dental evaluation before treatment

Whenever possible, an oral and dental examination should be done before starting cancer treatment. Cavities, tooth-related infections, gum problems and areas irritating the oral tissues are evaluated. The aim is to identify sources that could cause problems during treatment.

The priority and timing of necessary procedures are decided together with the pediatric hematology-oncology team. Cancer treatment should not be postponed by the family for dental procedures. The dentist should know the treatment schedule, the medications used and current blood values.

How is oral and dental care done during chemotherapy?

1. Gentle and regular cleaning

Care is usually done twice a day with a soft-bristled toothbrush and an age-appropriate amount of fluoride toothpaste. Young children are supported by their parents.

If brushing becomes difficult due to mouth sores or bleeding, the treatment team is consulted without stopping care completely. The brush and cleaning method are adapted to the child's pain and the condition of the oral tissues.

2. Personalized oral care products

Alcohol-containing mouthwashes are avoided. Mouthwashes, antiseptics, pain relievers or antifungal medications are not started on your own. The use of mouthwash should also be suitable for the child's ability to spit out the product without swallowing it.

Not every product used to relieve mouth sores is suitable for every child. The product should be chosen by the team following the child.

3. Care when cleaning between the teeth

The use of dental floss is evaluated considering the child's ability and whether they can use it without damaging the tissues. If there is pain or bleeding, support should be obtained from the dentist regarding the method.

4. Supporting nutrition and fluid intake

When there are mouth sores, very hot, hard, spicy and acidic foods can increase discomfort. Foods the child can tolerate are preferred; adequate nutrition and fluid support are planned with the treatment team.

For a child who cannot eat or drink water due to pain, just changing foods may not be enough. The treatment team should be informed.

5. Planning dental procedures with the treatment team

During periods when immunity is suppressed, non-urgent dental procedures may be postponed. An urgent problem, on the other hand, is coordinated with the oncology team without delay. The need for antibiotics and the safety of the procedure are evaluated separately for each child.

Do immune problems after leukemia last a lifetime?

It is not correct to say “lifelong low immunity” for every child. The recovery of immunity varies depending on the treatment received, a history of stem cell transplantation and ongoing medications.

In some children, especially if there is chronic graft-versus-host disease after a transplant or ongoing immunosuppressive treatment, susceptibility to infection may be prolonged. Graft-versus-host disease is when transplanted immune cells react against the recipient's tissues, and it can also affect the oral tissues.

Vaccinations may need to be re-evaluated; this plan is made by the child's follow-up team. Recurrent sores in the mouth, fungal infections and dryness should also be addressed during follow-up.

What matters here is creating a care plan suited to each child's treatment history and current health status rather than considering every child to be in the same risk group.

Why is dental follow-up important after treatment ends?

Long-term oral and dental problems are not only related to immunity. Some treatments applied at ages when the teeth are developing may affect:

• The structure of tooth enamel,
• The size and shape of the teeth,
• The development of tooth roots,
• The eruption time of permanent teeth.

Salivary gland problems may also be seen, especially after radiotherapy affecting the mouth area or certain transplant procedures. Reduced saliva can increase the risk of cavities, oral infections and difficulty chewing. These effects do not appear in every child.

A dental check-up every six months is generally recommended; the check-up interval may be shortened depending on cavity risk, dry mouth and other findings. Fluoride applications and preventive care are personalized.

Before orthodontic treatment, the tooth roots and development are evaluated; imaging is done as needed. This is why it is important to share the treatments the child has received in the past with the dentist.

When should you not wait?

During treatment, the oncology team should be contacted immediately in the following situations:

• Fever,
• Swelling in the face or mouth,
• Bleeding that does not stop,
• Rapidly increasing mouth or tooth pain,
• Mouth sores that prevent drinking water.

In case of fever, the emergency plan provided by the treatment team should be followed. Difficulty breathing or swallowing requires emergency evaluation.

Care that will last for many years, for little smiles

Turning oral care into a short and calm daily routine suited to the child's age and energy can make the care process easier for families. Listening to the child without forcing them, taking their pain seriously and maintaining communication with the treatment team are the foundation of this approach.

Being able to eat, talk and smile comfortably is an important part of a child's daily life. Protecting oral and dental health supports this everyday comfort.

As Dental Estetik Center, we remind you during Children with Leukemia Week: oral and dental health is part of holistic care both during and after treatment.

This article is for general information purposes; it does not replace the personal care plan of the child's hematology-oncology and dental teams.