Leukemia and The Mouth

Dr. André R. Clarke, DDS, MBBS Special Care Dentistry Leukemia is a malignant (cancerous) proliferation of abnormal blood-forming elements that progressively push aside normal blood-forming elements of the bone marrow. The destructive multiplication of abnormal cells, often causes a feeling of unwell and weakness in a person with leukemia. This is most likely due to the bone marrow’s failure as a result of the invasion of the abnormal cells. In addition to the feeling of unwell and weakness, the individual may also experience abnormal bleeding tendencies, along with a predisposition to infections. These two symptoms occur because of a decrease in the total number of blood clotting cells and a defect in the infection fighting cells of the bone marrow. Of note, when leukemia progresses, abnormal proliferating elements may infiltrate (get into) the gums, ears, central nervous system (CNS), liver and the spleen; affecting these areas negatively.

Healthcare professionals commonly classify the different types of leukemias according to the predominant cell types (lymphoid and myeloid) present. In addition, the degrees of maturity the cell variants exhibit, also impact the classification of the leukemias. When words like “acute” and “chronic” are used, they reflect the clinical course of the leukemias.

In the mouth, head and neck region, there are a number of findings that commonly follow a diagnosis of leukemia. They include severe bleeding, especially from the gum margins; infections with the herpes and varicella-zoster (chicken pox/shingles) viruses; infections with the fungus candida albicans; and even infections with the bacteria Escherichia coli and Klebsiella. Also, as mentioned in the first paragraph, gum swellings frequently occur as a result of infiltration of leukemia cells into them. Of note, the swellings occur particularly in Acute Myeloid Leukemia.

Mouth, head and neck findings other than the aforementioned, also occur as a result of leukemia: pale gums; gum ulceration; inflammation encircling the teeth; tonsillar swellings; loss of sensation around the lips (especially the lower lip); neck lymph node swellings; and painful swellings over the lower jaw and the parotid salivary glands. The parotid glands are found in the front of the ears; one gland on the left and the other on the right.

Of particular interest, is the common discovery made by a dental healthcare professional, taking mouth x-rays of a person with leukemia and noticing bone destruction around the teeth (especially the back teeth). This can be very alarming to the professional and the patient, but usually is reversible with chemotherapy treatment. It is therefore prudent that a dental professional works closely with the person with leukemia’s managing oncologist (cancer doctor) and/or physician. This will ensure that all aspects of the leukemia management and the patient’s life expectancy are always taken into account, before any decisions are made. One aspect that should not be overlooked is that antimicrobial cover is necessary for any surgery, especially if the individual has an indwelling catheter (tube) in the heart.

Persons with leukemia should aim for meticulous mouth cleanliness. It is advisable to consider daily rinses with warm chlorhexidine mouth rinses and to use a soft nylon toothbrush. Mouthwashes with fluoride should always be used in preference to those without. These are all generalizations, but the astute dental professional will tailor all mouth care, depending on the individual with leukemia’s particular need. The dentist will also assume close management of those individuals receiving chemotherapy treatment. A pre-chemotherapy; during chemotherapy; during remission; and long term treatment plan will be put together.

Remember that all parts of the body are connected and that bad cells can go anywhere. When those bad cells go into the mouth, head and neck area, the dental healthcare professional will exercise all of his expertise to help. He will work along with other healthcare specialists, to control the spread of and the effects of, the bad cells.

This article is for informational purposes only. It is not intended and may not be treated as, a substitute for professional medical/dental advice, diagnosis, or treatment. Always seek the advice of a physician or dental professional with any questions you may have regarding a medical/dental condition. Never disregard professional medical/dental advice or delay in seeking it because of a purely informational publication.