The Importance of Oral Care During Cancer Treatment

The Importance of Oral Care During Cancer Treatment

Tips to Help You Prevent Infections

by Jill Meyer-Lippert, RDH

Chemotherapy and other treatments for cancer can lower blood cell counts, including white blood cells (WBCs) that fight infection. When WBCs fall below a certain level, known as neutropenia, patients become susceptible to developing a variety of (bacterial, fungal, and viral) infections. If you are at risk for neutropenia, it is important to take extra precautions to prevent infections that could lead to a potentially life-threatening condition called sepsis. 

Ways to avoid sepsis include good hygiene, preventing cuts, avoiding germs from others, and monitoring for early signs of infection. Paying special attention to your mouth is an important aspect of infection prevention. 

People with cancer that enter into treatments with poor oral health are at elevated risk because untreated cavities, broken teeth, and gum disease can develop into infections that may spread from the mouth to other areas of the body. Therefore, it is ideal to see a dentist prior to starting treatments to make sure there are no dental concerns that need to be fixed. 

Being proactive with your oral care

Proactive dental care can resolve problems before WBCs are affected. Continue professional dental care during treatments with the approval of your oncologist. If blood counts fall too low, you may be advised to delay dental appointments until they have returned to safer numbers.  

The sticky dental plaque that builds up on teeth and gum tissue contains a variety of germs. Breathing in these germs can lead to respiratory infections, like hospital-acquired pneumonia, which is a serious complication. 

It’s important to remove plaque as thoroughly and gently as possible each day while avoiding tissue trauma because these germs can also enter into mouth sores or any cuts in the tissue to spread further. 

Clean your teeth, tongue, and gums by brushing morning and night and after meals with an extra-soft, compact head toothbrush. Soften the bristles under hot water as needed. Protect tissue by using gentle, circular strokes and avoid vigorous, heavy-handed scrubbing. 

Germs thrive on wet surfaces, so it’s best to allow your toothbrush to dry thoroughly between uses or switch between two brushes if needed. Replace your toothbrush at the first sign of bending or fraying of the bristles because damaged bristles cannot remove plaque effectively.

Use floss, water flossers, and other devices to clean between your teeth (where toothbrush bristles can’t reach) only with the approval of your oncology healthcare team, which will depend on blood counts. Your dental hygienist should demonstrate the proper use to avoid cutting the tissue.  

Treating dry mouth and lips and avoiding germs

Saliva naturally protects against infections and lubricates tissue to avoid trauma. Ask a trusted dental professional for recommendations on products to reduce dry mouth symptoms while protecting against cavities. 

Some common remedies, like sucking on candy or cough drops, can damage teeth. Avoid licking lips and using lip balms that contain petroleum. Petroleum does not hydrate lips and places a barrier that can trap bacteria underneath. 

Avoid introducing germs into your mouth by storing your toothbrush away from possible contaminants, such as touching other family members’ brushes or being exposed to a flushing toilet. Be sure to wash hands thoroughly before putting your fingers in or around your mouth when flossing or using other oral hygiene devices. 

Do not share items like toothbrushes, lip balm, or unwashed cups and eating utensils as these can transfer germs from others. Use your own tube of toothpaste or be very cautious to not touch the tip of the toothpaste tube to your toothbrush when dispensing paste to not pass germs from one person to the next.  

Keeping an eye out for any signs of infection

Monitor in and around your mouth for any concerns or potential signs of infection, and alert your healthcare providers if you notice:

  • Tooth, gum, or jaw pain 
  • Swelling, open sores, or bleeding
  • Drainage or a “pimple” on your gum tissue
  • A change in breath smell or a bitter taste in your mouth
  • Loose teeth or exposed bone
  • Color changes in tissue, including a white film that could indicate thrush 
  • Persistent soreness or cracking at the outside corners of your mouth. This can be a sign of a fungal infection called angular cheilitis.
  • Fever

Protecting yourself from infection is well worth the effort! Paying close attention to your mouth and making oral health a priority can help cancer treatments to be more comfortable and safer. 

Jill Meyer-Lippert, RDH, is the founder of Side Effect Support (, an online resource for helping people with cancer to reduce oral side effects of treatments. Jill is a 2014 recipient of the Sunstar Americas/RDH Award of Distinction, holds a certificate in Oncology Management, and is an instructor for the National Network of Healthcare Hygienists’ Oncology Certificate Program. She is a member of the Registered Dental Hygienist Advisory Board for the Oral Cancer Foundation and was named one of the “6 Dental Hygienists You Want to Know” by Dimensions of Dental Hygiene magazine in 2022.