The Oral Complication Pausing Cancer Treatments and Harming Children

It is estimated that over two million people were diagnosed with cancer in the United States in 2024—approximately 5,600 people every single day [1]. While modern medicine has made incredible strides in oncology, there is a devastating side effect of cancer treatment that frequently goes unmanaged, causing immense suffering and even threatening lives: oral mucositis.

As dental professionals, we are the experts in the oral cavity. Yet, if a patient undergoing chemotherapy or radiation walked into your operatory today with severe oral mucositis, would you feel fully prepared to treat them? For many of us, the honest answer is no. But now that we know the profound impact this condition has on cancer survival, we have an unprecedented opportunity to do better.

The Hidden Crisis of Oral Mucositis

Oral mucositis is widely considered the most severe non-hematological complication of anticancer therapy. It affects up to 80 percent of patients undergoing chemotherapy and nearly all patients receiving radiation for head and neck cancers [2].

This condition is far more than just painful mouth sores. The severe ulcerations associated with oral mucositis make eating and swallowing nearly impossible. As the mucosal barrier breaks down, the risk of opportunistic infections skyrockets. Secondary infections occur in roughly 70 percent of patients with oral mucositis [3]. When these pathogens enter the bloodstream, they can lead to bacteremia and life-threatening sepsis.

The consequences directly impact cancer survival. In approximately 11 percent of cases, severe oral mucositis forces oncologists to delay, modify, or permanently discontinue life-saving radiation or chemotherapy [4]. When cancer treatment is paused, the prognosis worsens.

The Impact on Pediatric Patients

The statistics become even more heartbreaking when we look at children. Childhood cancer is the second leading cause of child mortality worldwide [5]. In pediatric cancer patients, the incidence of oral mucositis can reach up to 100 percent depending on the treatment regimen [6].

For a child, severe oral mucositis is exceptionally dangerous. The breakdown of the oral mucosa poses a massive risk for systemic infection, directly contributing to reduced patient survival. The tragedy is that many of these severe complications are preventable. Research consistently shows that implementing comprehensive oral care protocols and providing targeted oral health education can significantly reduce both the incidence and severity of oral mucositis in children.

The Gap in the System—And Our Opportunity to Close It

Despite the severe impact of oral mucositis on treatment outcomes, most cancer treatment centers do not have a registered dental hygienist or oral health specialist on staff. In many facilities, the standard of care is limited to a brief oral surgery consult and necessary extractions prior to treatment. Comprehensive oral hygiene assessments and ongoing management during therapy are frequently missing.

This is where the community dental home must step in. By collaborating directly with local oncology treatment facilities, dental providers can ensure patients receive essential oral care before, during, and after their cancer treatment.

When we proactively manage the oral environment, we reduce the risk of secondary infections and help keep cancer treatment schedules on track. Effective management of oral mucositis allows oncologists to maintain aggressive therapeutic doses, ultimately improving patient survival rates.

Stepping Into the Future of Integrated Oncology Oral Care

The lack of preparedness in our industry is not a cause for shame; it is a call to action. As more oncology teams recognize that proper oral hygiene saves lives and prevents treatment interruptions, the demand for specialized dental professionals will grow. This shift has already lead to the creation of new integrated jobs for dental hygienists within multidisciplinary medical teams.

Katharine Martinez, MPH, RDH, Oral Health Educator at Phoenix Children's Hospital and Instructor in the Oncology Oral Care Certificate Program, captures this beautifully:

"Despite extensive training and expertise, many dental hygienists struggle with imposter syndrome, questioning their place in medical settings like oncology care. It's important to recognize that dental hygienists bring a wealth of knowledge that can significantly impact patient outcomes. Your expertise in oral health is a vital component of comprehensive cancer care. By stepping confidently into these roles, you not only enhance patient care but also educate medical teams about the essential link between oral and systemic health."

We have the power to elevate our standard of care and become true integrative health partners. We can do better, and we will. Let us commit to mastering the management of oral mucositis, ensuring that no patient—especially a child—has to pause their life-saving treatment due to a preventable oral condition. Our patients are counting on us, and we are ready to rise to the occasion.

Are you ready to step confidently into oncology care and close the gap in your community?

View the Oncology Oral Care Certificate Program today and learn how you can become a vital partner in your patients' cancer journey. 

References

[1] American Cancer Society. (2024). Cancer Facts & Figures 2024. Atlanta: American Cancer Society. 

[2] Lalla, R. V., Bowen, J., Barasch, A., Elting, L., Epstein, J., Keefe, D. M., ... & Sonis, S. T. (2014). MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer, 120(10), 1453-1461. 

[3] Sonis, S. T. (2009). Mucositis: The impact, biology and therapeutic opportunities of oral mucositis. Oral Oncology, 45(12), 1015-1020. 

[4] Elting, L. S., Cooksley, C., Chambers, M., Cantor, S. B., Manzullo, E., & Rubenstein, E. B. (2003). The burdens of cancer therapy: clinical and economic outcomes of chemotherapy-induced mucositis. Cancer, 98(7), 1531-1539. 

[5] World Health Organization (WHO). (2021). CureAll framework: WHO global initiative for childhood cancer. 

[6] Ye, Y., Carlsson, G., Agholme, M. B., Karlsson, E. A., Winiarski, J., & Mellgren, K. (2021). Oral mucositis in pediatric cancer patients: A systematic review and meta-analysis. Frontiers in Oncology, 11, 650082.