Leukemia is a type of blood cancer whereby there is an abnormal increase of immature/ primitive white blood cells. White blood cells function by producing antibodies to fight off infection from our body. Leukemia patients are more prone to infections as their abnormal white blood cells cannot produce antibodies.
What are the different types of leukemia?
Leukemias are classified based on the clinical cause (whether it occurs in a short duration (acute) or long duration (chronic); cells of origin (lymphoblast/ non lymphoblast).
- Acute lymphocystic leukemia /ALL
– Often occurs among young children
– Causes of ALL can be due to exposure to radiation/ chemicals.
– ALL is characterized by proliferation of malignant immature white blood cells in the bone marrow.
- Chronic lymphocytic leukemia /CLL
– Often occurs among adults
– Can be asymptomatic at times
– Prognosis of chronic leukemia is better than acute leukemia
- Acute myelogenous leukemia/ AML
Similar to CLL, it is more common in adults and is a fast growing cancer.
- Chronic Myelogenous leukemia/ CML
- There is an increase and accelerated growth of the myeloid cells ( a type of cells in bone marrow)
Clinical features of leukemia:
The clinical features of all types of leukemia are similar as they involve the disruption of the bone marrow function.
- Loss of weight
- They are prone to infection and they bleed easily
- Hepatosplenomegaly (They might have large spleen and liver)
Treatment of leukemia is usually chemotherapy/ radiotherapy or combination to kill the cancer cells. Bone marrow transplant is indicated where aggressive chemotherapy/ radiotherapy is required.
Here are some dental manifestations in leukemia patients:
- Oral bleeding
- Petechiae (red spots) on the mucosa
- Gingival swelling can occur in 20 -30% of the patients
- Ulcers are often found on the mucosa or gingival
- Candidiasis / oral thrush
- Oral infection is common
Dental management of leukemia patients
Dental management of leukemia patients can be complicated by the compromised host defenses against infection.
The dentist should:
- Always discuss with the medical practitioner if any dental treatment is required. A thorough history is needed prior the dental treatment. (information on the underlying disease, time of the diagnosis, modalities of treatment and etc)
- Hematological information is needed before any invasive procedures (such as extractions)as leukemia patients have higher bleeding tendencies and they are liable to infections.
- Preventive oral care is important in leukemia patients. Early intervention is important to reduce the possible complications.
- Frequent topical fluoride applications
- Fissure sealants on the molars to reduce dental caries.
- Dietary advice to the patient
- Give proper tooth brushing instructions to both patient and parents.
- Antibiotic cover is needed before any surgery to prevent any postoperative infection.
- Local anesthesia should be avoided to prevent any hemorrhagic tendency.
- Root canal treatment is preferred over extractions to reduce the risk for oral and systemic complications
- Dental treatment should be performed as a traumatically as possible to prevent any injuries to the soft tissues.
- Fixed and removable orthodontic appliances are not recommended for patients with poor oral hygiene.
- Preshedding deciduous teeth should be left to exfoliate naturally and patient should not play with it with his/her tongue to reduce bacteremia.
- Local measures such as placing sutures, gelatin sponge are required to stop/ arrest bleeding when a minor/major surgery is performed.
- Leukemia patients should maintain their oral hygiene by:
- Brush twice daily using a soft toothbrush to reduce the risk of significant bleeding and infection of the gingival.
- Attending the dental appointments regularly to monitor their oral condition.
- Remove plaque effectively to prevent formation of dental caries
- Rinse after meal to avoid accumulation of plaque/food debris