A nurse is assessing the mouth of a client who has candidiasis an oral fungal infection
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Note: This guideline is currently under review. Show
Introduction Aim Definition of Terms Assessment Management Dental Considerations Other Considerations Companion Documents Evidence Table References IntroductionOral mucositis is a common complication of chemotherapy and radiotherapy. Chemotherapy alters the integrity of the mucosa, the normal microbial flora of the oral cavity, salivary quantity and composition,
as well as epithelial maturation. As a result, the child receiving chemotherapy may experience pain, dysphagia, alteration in nutritional status, and risk of infection. AimThe aim of this guideline is to provide a comprehensive overview of the oral care of the paediatric oncology and haemopoietic stem cell transplant patient. Definition of Terms
AssessmentAssessment by a dentistAll children diagnosed with cancer or receiving a haemopoietic stem cell transplant should be screened by a paediatric dentist prior to the commencement of treatment. All children diagnosed with cancer or receiving a haemopoietic stem cell transplant should be reviewed by a paediatric dentist at least every 3-4 months during active treatment and then every 6-12 months after completion of treatment. The paediatric dentist will;
Further information on dental management of the paediatric oncology and the haemopoietic stem cell transplant patient can be found at
Daily assessmentAll patients being treated for childhood cancer or undergoing a HSCT require daily assessment of
the oral mucosa. Each of the eight categories is scored 1, 2 or 3.
The OAG provides parameters for the assessment of each child's mouth and the implementation of a plan of care based on these findings. Results of the assessment should be clearly documented in the Electronic Medical Record. The OAG Assessment tool should be added for all paediatric oncology and HSCT patients under the ENT assessment in the Focused Assessment flowsheet. Oral Assessment Guide (OAG)
*Oral Assessment Guide- adapted from Eilers et al (1988) by the mouth care working party, Great Ormond Street Hospital for Children NHS Trust (2005) Management Recommended management for oral hygiene in paediatric oncology and HSCT patients
The management plan should be clearly documented in the Electronic Medical Record. Toothbrushing
Toothpaste
Chlorhexidine based gels or mouth rinses
Flossing and interdental brushes
Pain management
Low Level Laser/Light Therapy (LLLT)LLLT has been shown to improve therapeutic outcomes and reduce the prevalence and severity of oral mucositis in oncology patients by promoting healing, reducing inflammation and increasing cell metabolism. Studies have shown that LLLT may:
All patients undergoing a HSCT or patients receiving high doses of chemotherapy agents such as COPADM should be referred
by the treating team to the Dentistry department for LLLT prior to commencing chemotherapy. Other patients should also be referred Cryotherapy
Anti-fungal agentsProphylaxis of Oral Candida
Treatment of Oral Candida
Further information on the prevention and management of fungal infections in the paediatric oncology and the HSCT patient can be found at: Anti-viral agentsAciclovir is recommended as a prophylactic and treatment measure for herpes simplex virus in patients undergoing haemopoietic stem cell supported therapy Further information on the prevention and treatment of viral infections in the HSCT patient can be found at Guideline (CCC): Infection: Prophylaxis and Treatment in Haematopoietic Progenitor Cell Transplantation Dental Considerations
Other considerationsA multidisciplinary approach to oral care (nurse, medical officer, dentist, pain management team, procedural pain management team, dietician, pharmacist and others) will assist in providing appropriate supportive care to the paediatric oncology patient Several therapy and patient specific factors,
including the chemotherapy drug, the type of malignancy, age, neutrophil count and level of oral care are important in the pathogenesis of oral mucositis
Further points to consider;
Companion DocumentsInformation for ParentsParent Information Sheet; Mouthcare – Taking care of your child's TEETH and MOUTH after chemotherapy or a bone marrow transplant Other parent information:
Information for Health Professionals
Evidence TableThe evidence table for the Mouth Care – Oral Care of the paediatric oncology patient and haematopoieitic stem cell transplant patient can be found here. References
Please remember to read the disclaimer. The development of this nursing guideline was coordinated by Lisa Barrow, Clinical Nurse Educator, Children's Cancer Centre and approved by the Nursing Clinical Effectiveness Committee. Updated December 2018. When assessing the throat the nurse notice bright red throat with white or yellow exudates This indicates?Strep throat is the most common bacterial cause of tonsillar exudates and can result in white or yellow exudate that often has a foul smell. Depending on the cause, tonsillar exudate can last anywhere from a few days to 4 weeks.
Is a thick white patch of cells in the oral cavity that may be precancerous?Leukoplakia appears as thick, white patches on the inside surfaces of your mouth. It has a number of possible causes, including repeated injury or irritation. It can also be a sign of precancerous changes in the mouth or mouth cancer.
Which instructions should the nurse provide to the client taking a sublingual medication?Place the sublingual pill under the client's tongue. 5. Instruct the client not to swallow the tablet. They are not to eat, drink, or smoke until the medication is dissolved.
Which characteristic of the gums should a nurse expect to assess in a client who is healthy?Red, swollen, bleeding gums are seen in gingivitis, scurvy, and leukemia. The nurse may find enlarged, reddened gums as an adverse effect of phenytoin treatment. Pink, moist, firm gums are normal findings of the gums.
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