Leukemia and Oral Health
Dental check-ups can reveal more than just the condition of your teeth. Serious illnesses like leukemia can lead to sensitive or infected gums and are often among the first symptoms of the disease. Patients sometimes mistake signs of leukemia for gum disease and schedule an appointment with their dentist. That’s why it’s not uncommon for the disease to be discovered in the dental chair.
“I’ve run into the situation twice in my career where we’ve been in the position of advising a patient to seek medical care for what turned out to be leukemia,” says Dan Peterson, DDS, a general dentist at Family Gentle Dental Care in Gering, Nebraska. Dr. Peterson describes the oral signs of leukemia as unique. “The gum tissue appears reddish/purple and is puffy. The tissue also looks like it is trying to separate from the tooth.”
Leukemia and Oral Health Impact
A 2010 study published in the Indian Journal of Dental Research looked at 30 patients ranging in age from 5 to 65 years and discovered that oral symptoms in all types of leukemia can be an indicator of the disease.
In leukemia, the white blood cells that help fight infection don’t fully mature. They also grow rapidly, limiting the production of other blood cells. This leads to an increased risk of bruising, bleeding and infection. Symptoms of leukemia that can be detected during a routine dental examination include bleeding from the gums, mouth sores, enlarged lymph nodes and gum infections.
Chemotherapy and radiation, common leukemia treatment therapies, not only destroy cancer cells, they can also damage the cells that line the mouth leading to infections and sores on the mouth, lips, tongue and gums.
It’s estimated as many as 90 percent of children who receive treatment for leukemia have oral complications. Adults can also suffer oral side effects. Addressing dental problems before beginning treatment and maintaining good oral hygiene throughout the course of therapy can reduce the risk and severity of complications.
Oral Care Before, During and After Leukemia Treatment
During treatment for leukemia, the immune system is suppressed. As a result, the risk of infection is dramatically increased. Minor infections and conditions that have been dormant can easily flare and even become life threatening.
Before starting treatment, a thorough dental checkup is recommended to look for oral lesions or any underlying conditions that could lead to serious infection or affect the ability to eat. Once treatment begins, precautions should be taken to maintain oral health, and that includes stepping up the frequency of dental exams. “The oral care of those with leukemia is similar to that of someone with periodontitis. We usually see them in the office every three months for check-ups and cleanings. We’re very focused on maintenance and keeping bacteria under control,” says Peterson.
Patients who are receiving chemotherapy and/or radiation therapy have a higher risk of oral complications. Rinsing frequently with cold sterile water or saline solution keeps the mouth clean and moist, and brushing after every meal, or at least twice a day, with a soft brush is recommended. Mouth ulcers are common throughout treatment and can become so painful that brushing is almost impossible.
For patients with severe gum problems, Peterson recommends using a Rotadent® toothbrush available through dental professionals. “It works like a toothbrush but instead of a brush, there’s a special polishing cup on the end,” he says. A special mouthwash may also be recommended to reduce bacteria and decrease the risk of infection.
Any dental emergencies that happen during the course of treatment should be coordinated between the dentist and medical doctors, since the risk of infection is higher during certain phases of treatment. Once treatment ends, it’s important to continue dental visits every three months for the first year. After that, routine cleanings and examinations should be faithfully scheduled every six months.
Long-Term Effects of Leukemia and Oral Health
Children who receive chemotherapy during the most active phases of tooth development may experience later complications including changes in enamel, abnormal root formation and problems with jaw growth.