Oral Health Can Affect Treatment Readiness

For children, adolescents and young adults receiving high-dose chemotherapy or radiation therapy, preparing for hematopoietic stem cell transplantation (HSCT) or undergoing other immunosuppressive therapy, untreated dental disease represents a high-risk source of infection that may affect treatment readiness.

Chemotherapy and radiation can damage the oral mucosal barrier, allowing bacteria from the mouth to enter the bloodstream. Existing decay may also require treatment before chemotherapy or HSCT, creating a difficult clinical balance when cancer treatment is urgent.

“If a patient’s mouth isn’t ready for a stem cell transplant—or if they’re receiving high doses of chemotherapy—they can be at high risk for infections,” says Christine Phillips, MD, medical director of the Division of Oncology at Cincinnati Children’s Cancer and Blood Diseases Institute who specializes in leukemia and lymphoma. “It’s critical for infection control to have their mouth in good shape.”

Accessing appropriate dental care can also be challenging. Community dentists may be hesitant to treat children undergoing active cancer therapy because of their complex medical needs. Additionally, many patients are often referred to a medical provider due to disease complexity.

To address these challenges, Cincinnati Children’s established a dedicated dental treatment space within the Cancer and Blood Diseases Institute. The embedded service, funded by a grant through the American Academy of Pediatric Dentistry, allows hematology, oncology and transplant patients to receive dental exams, cleanings, fluoride treatments and X-rays as part of their care, with specialized pediatric dental expertise available to support their complex medical needs.

Integrating Dental Expertise into Cancer and Transplant Services

More than a decade of collaborative research at Cincinnati Children’s into pretransplant oral health and oral infections helped inform the embedded model.

Sarat Thikkurissy, DDS, MS, MA, a pediatric dentist in the Division of Pediatric Dentistry and Orthodontics with a joint appointment in the Division of Bone Marrow Transplantation and Immune Deficiency, partnered with colleagues in the Cancer and Blood Diseases Institute to establish a dedicated dental treatment space for patients in cancer and transplant care pathways.

Previously, these patients received care through the main campus dental clinic, without a designated dentist specializing in considerations such as central lines, antibiotic prophylaxis, and timing dental procedures around treatment. The new space includes equipment selected with immunocompromised patients in mind. More extensive dental treatment can be coordinated through the hospital’s dental clinic or operating room under anesthesia.

With this new model, there is lower risk of infection from transporting patients across the hospital, and oral health is integrated into routine visits, allowing families, nurses and physicians' immediate access to oral health care.

Coordinating Dental and Specialty Care

The embedded model allows dental, oncology and transplant specialists to make treatment decisions collaboratively. Dr. Thikkurissy can consult in real time with physicians, nurses and care coordinators about whether dental intervention is necessary, when a procedure can be performed safely and what preventive medications a patient may need.

Transplant physicians now include dental evaluation as part of pretransplant screening, while oncologists can refer patients as concerns arise. Appointments can often be coordinated with existing oncology visits, helping incorporate oral health into the broader treatment plan.

Early Experience Demonstrates an Access Need

Since the dedicated dental space opened, Dr. Thikkurissy has treated nearly 150 patients, ranging from 12 months to 41 years old, with an average age of 11 years. Approximately 30% of these patients had previously been unable to find a community dentist to provide care.

While the team continues to evaluate the long-term impact, the early experience demonstrates an important access need for patients with complex cancer and transplant care needs. Approximately 30% of patients seen require treatment in an operating room setting due to age, anxiety and complexity of dental needs.

Supporting Ongoing Care Close to Home

For families managing cancer or transplant treatment, dental care can understandably become secondary to more immediate treatment demands. Integrating dental services into existing care workflow helps teams address oral health needs without requiring families to independently coordinate another aspect of care.

The goal is not to replace a patient’s community dentist. Thikkurissy works with dentists across the country to share treatment considerations, determine when community-based dental care can safely resume and identify patients who may still require hospital-based care.

Connect with Our Team

For questions about managing oral health during cancer treatment or stem cell transplant, or to discuss whether a patient may benefit from specialized dental evaluation, contact Dr. Thikkurissy at sarat.thikkurissy@cchmc.org.

(Published November 2026)

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