Leukemia

Oral health effects

• Gingival enlargement and bleeding

  Leukemic infiltration can cause swollen, spongy, bleeding gingiva, sometimes a presenting sign, particularly in acute myeloid leukemia.

  Mechanism: Infiltration of leukemic cells plus thrombocytopenia.

  Clinical management: Recognize as a possible first presentation; refer urgently for medical evaluation. Gentle hygiene, manage bleeding.

• Mucosal ulceration and infection

  Immunosuppression and chemotherapy increase ulceration and infection risk.

  Clinical management: Supportive oral care; coordinate with oncology.

• Painful mouth sores from chemotherapy (oral mucositis)

  Chemotherapy and stem-cell transplant commonly cause oral mucositis (about half of children during ALL treatment): red, ulcerated, painful mucosa that limits eating and can become infected.

  Clinical management: Coordinate with the oncology team; before treatment, eliminate sources of infection; during treatment recommend a soft brush, bland rinses (saline/bicarbonate) and avoid alcohol rinses; follow MASCC/ISOO-recommended protocols (e.g., oral cryotherapy for some regimens).

• High tooth decay rate during treatment (dental caries)

  Caries is the most frequent oral finding in children treated for acute lymphoblastic leukemia (around 80%), driven by sugary medicines, vomiting, diet change and reduced oral hygiene.

  Clinical management: Intensify fluoride (varnish, high-fluoride toothpaste when age-appropriate); give dietary advice; schedule short-interval recalls coordinated with blood counts.

• Developmental tooth defects in childhood survivors (enamel hypoplasia, missing or small teeth)

  Children treated for leukemia while teeth are forming often develop enamel hypoplasia, missing teeth (agenesis) or small teeth (microdontia) and short roots.

  Clinical management: Ask about childhood cancer history; take this into account in radiographic interpretation, orthodontic and restorative planning; protect hypoplastic enamel with sealants/fluoride.