Pediatrics and Oncology Case Study


“For increasing the interprofessional approach to patient care. ”

Our Smallest Cancer Patients Need Healthy Teeth Too


Dental caries (the infectious process that leads to cavities) frequently causes serious problems for children before and after cancer treatment.  Because these children’s immune systems are compromised, they are at greater risk for infections.

Thedevelopment of oral problems during cancer care results in pain, fever, more hospitalizations, increased cost, and delays in treatment.

Because attention to oral health is not incorporated into oncology care, the significance of dental problems is seldom recognized by pediatric oncologists, nurse practitioners and nurses. When it is recognized, the medical team often lacks the knowledge and skills—and support from their institutions—to conduct an oral assessment.

Up to 90% of pediatric cancer patients develop oral health problems, most of which could have been prevented with early assessment as part of their treatment.

You can change this in your institution. Here’s how.


Dr. Erin Hartnett, DNP, APRN-BC, CPNP,  program director for NYU College of Nursing oral health program, for the national OHNEP program (Oral Health Nursing Education and Practice), and for the national TOSH program (Teaching Oral Systemic Health) program. OHNEP is funded by: DentaQuest Foundation, Washington Dental Service Foundation, and Connecticut Health Foundation. TOSH is funded by the Health Services and Resources Administration.

Dr. Erin Hartnett developed and implemented a program that has successfully integrated oral health care into oncology treatments at The Hassenfeld Center for Children with Cancer and Blood Disorders, where Dr. Hartnett is a pediatric nurse practitioner in pediatric neuro-oncology. The Center, part of NYU Langone Medical Center, is one of the nation’s leading pediatric oncology outpatient facilities.



Oral assessment and fluoride varnish are now part of the assessment and treatment of all oncology patients when oncology staff works together with dental staff to prevent and treat any dental problems.

A “Standard of Practice”

“This educational program was adopted as a standard of practice at the Center and all providers complete this oral health program,” reports The American Association of Colleges of Nurses, which in 2012 awarded Dr. Hartnett a Capstone Project Award for Excellence in Advancing Nursing Practice for her work.


When Dr. Hartnett’s project began, none of the oncology providers (MDs, NPs, RNs) had included this in their practice.  Now, all children receiving cancer treatment get an oral assessment and fluoride varnish.



Dr. Hartnett developed an approach that OHNEP recommends be used by pediatric oncology practices in medical centers and other institutions.


  • Watch Dr. Hartnett's OHNEP-sponsored webinar (Part 1 & Part 2) and learn what to cover in classroom and clinical training so you can incorporate oral health care assessments into your pediatric oncology practice
  • OHNEP Resources for publications, videos and presentations, and more case studies
  • Children’s Oncology Group. Treatment for cancer during childhood increases the risk for dental problems both after treatment. Learn about the risk factors and overall dental care for pediatric cancer survivors.


She got approval from the Institutional Review Board (IRB) and the green light from all involved before implementing the oral health program. Dr. Hartnett worked collaboratively with the Director of  NYU Pediatric Hematology/Oncology, Nursing Director of Outpatient Operations, Chairman of NYU Pediatric Dentistry, NYU pediatric dental residents,  Hassenfeld oncology providers, materials management, the pharmacy and the IT department to ensure that educational and clinical skills training, supplies, Electronic Health Records (EHR), and billing were all coordinated.

She held classroom and clinical training in oral health assessment in the Hassenfeld Center for the oncology providers (MD, NP, RN). The curriculum combined modules from the American Academy of Pediatrics Oral Health Initiative with modules Dr. Hartnett created specifically for pediatric oncology. This AAP curriculum is no longer available but a similar curriculum can be found at and Smiles for Life