Leukemia

Presented by
1-Raghad shawkat
2-Raghad Raad
3-Zahraa Hussain
4-Jannat Hazim Supervised by
5-Rahaf Jasim Dr. Malath Nabeel
 Introduction

The early signs of leukemia can usually manifest

in the oral cavity due to infiltration of leukemic
cells or due to associated decline in normal
marrow elements, especially in the acute phase
of leukemia, as common lesions at this stage of
the disease can be screened and diagnosed by
the dentist
 What is leukemia

Leukemia is a malignant disease of blood-

forming tissues such as the bone marrow and
causes a large number of immature blood cells
to be produced and enter the blood stream
 Classification
Leukemia is mainly classified according to the :-
1- duration into
A-acute
B- chronic

2-type of cell affected

A-myeloid
B- lymphoid
C-monocytic
Leukemia Causes and Risk Factors

1-Smoke.
2-exposed to a lot of radiation or certain
chemicals.
3- radiation therapy or chemotherapy to
treat cancer.
4- family history of leukemia.
5- genetic disorder like Down syndrome.
 Detect the disease
In fact, a dentist may be the first doctor to detect the
cancer. Leukemia, as well as subsequent
chemotherapy, has a distinct effect on dental health,
which means that dental hygiene should be a priority
when you're fighting the disease.

Early clinical sign of myeloid leukemia

 Diagnosis of leukemia

is made by physical examination. Usually there is

fever, fatigue and several enlarged lymph nodes,
sometimes accompanied with
hepatosplenomegaly
Complete blood count (CBC) should be carried
out (WBC, RBC and platelets). Additionally, a
bone marrow biopsy should be made, to check
the presence of leukemic cells in the bone
marrow
 Diagnosis of leukemia
Other tests are usually performed to determine
the specific type of leukemia by assessment of
chromosome abnormalities (cytogenetic ) and
lumbar puncture to investigate for the presence
of leukemic cells in the cerebrospinal fluid (CSF)
Common leukemia signs and symptoms
include:
1-Fever or chills.
2-Persistent fatigue, weakness.
3-Frequent or severe infections.
4-Losing weight without trying.
5-Swollen lymph nodes, enlarged liver or spleen.
6-Easy bleeding or bruising.
7-Recurrent nosebleeds.
8-Tiny red spots in your skin (petechiae)
Does leukemia affect the teeth
Although swollen gums are
normally a sign of poor oral
hygiene, sometimes leukemia
cells can make their way from
the blood into the gum tissue,
causing them to slowly swell
over time. In very pronounced
cases, the teeth may start to
become covered by the
swollen gums.
How can a dentist know if you
have Leukemia
There are few reports of oral ulceration as first
manifestation of leukemia. oral ulceration with
necrotic slough and erythematous periphery on
gingival margin as first sign of Acute Myeloid. Oral
lesions may be the first and only manifestation of
potentially fatal conditions like leukemia. Such oral
mucosal lesions are likely to be encountered by
dermatologists, otolaryngologists, dentists
Dentists should be aware of clinical manifestations
of systemic diseases that can play a vital role in early
diagnosis.
Oral manifestations
1- gingival bleeding
2- gingival hypertrophy
3-nonspesific ulceration
4-jaw pain
5- loose teeth
6-extruded teeth
7-gangrenous stomatitis
Oral manifestations

8-infections and bone alterations are common

manifestations of leukemia.
9-Leukemic infiltration can cause gingival swelling
which may be the most constant findings of the
disease.
 Oral manifestations
10- Opportunistic infections with Candida
albicans and Herpes viruses are common and
can involve any area of the mucosa
11- Ulcers can also result from impaired
immune defense in combating normal microbial
flora
Dental treatment and Oral Complications

A-Chemotherapy
Most of the oral complications caused by
chemotherapy are short term and typically resolve
after treatment ends. Oral complications caused by
chemotherapy include :-
1-Mouth sores (oral mucositis)
2-Bleeding in the mouth
3-Dry mouth (xerostomia)/salivary gland dysfunction.
4-Tooth decay and gum disease
5-Infection
Dental treatment and Oral
Complications
6-Pain
7-Difficulty swallowing (dysphagia)
8-Changes in taste
9-Neurotoxicity
10-Changes in dental growth and
development occur in children
11-Malnutrition or dehydration
Dental treatment and Oral
Complications
B-Radiation to the head and neck
Oral complications caused by radiation therapy include:
1-Breakdown of tissue, bone or muscle in the area receiving radiation
2-Tooth decay and gum disease
3-Mouth sores (oral mucositis)
4-Infection
5-Pain
6-Dry mouth (xerostomia)/salivary gland dysfunction
7-Difficulty swallowing (dysphagia)
8-Changes in taste
9-Changes in dental growth and development occur in children.
10-Malnutrition or dehydration
 Before dental treatment
Good dental hygiene, before and during cancer
treatment; The goal is to treat existing oral problems
before treatment begins and to become educated about
the potential risks, side effects and complications of
therapy.

When treatment is not urgent, patients should visit a

dentist at least four weeks before treatment starts. A
pretreatment oral evaluation will identify problems such
as cavities, fractured teeth, loose crowns or fillings, or
gum disease. These problems should all be addressed in
order to reduce the risk of complications.
 During Cancer Treatment

patients can take the following steps to help improve their oral health:

1-Brush teeth and gums two to three times a day.

2-Use a fluoride toothpaste with a mild taste—flavorings can irritate the
mouth.
3-Gently floss once a day.
4-Every 2 hours, rinse the mouth with a solution of water, salt and baking
soda to prevent soreness.
5-Use an antibacterial rinse two to four times a day to prevent gum
disease.
6-Use a lip-care product to prevent your lips from drying and cracking.
7-Brush dentures every day, clean with a denture cleaner recommended
by the dentist, and keep dentures moist when not being worn.
During Cancer Treatment

8-Ask about fluoride treatments that may be

recommended to prevent cavities or tooth
sensitivity.
9-Talk with your doctor about ways to improve
bone health with vitamin D and/or calcium
supplements.
10-Look in your mouth every day and note
sores or other changes. Take steps to help
prevent and treat a sore mouth
Dental treatment
Dental treatment of patients with leukemia should be
planned on the basis of antineoplastic therapy which
can be chemotherapy with or without radiotherapy and
bone marrow transplantation.
In addition, performing dental procedures at different
stages of treatment (before, during, or after) must
follow certain protocols in relation to the hematological
indices of patients, aimed at maintaining health and
contributing to the effectiveness of the results
of antineoplastic therapy
Pre-Antineoplastic Treatment Assessment
and Patient Preparation
The objectives of the pre-antineoplastic treatment
dental evaluation are as follows

(1)identify and eliminate sources of existing or

potential infection
(2)educate the patient (or their relatives) about
the importance of maintaining oral health in
reducing problems and oral discomfort before,
during, and after cancer treatment
Pre-Antineoplastic Treatment
Assessment and Patient Preparation
(3)warn about the possible effects of
antineoplastic therapy in the oral cavity, such as
mucositis.

(4)identify specific issues of the diagnosis of

leukemia, such as leukemic infiltrates in oral
tissues.
Oral Health Care during Antineoplastic
Treatment
The objectives of dental care during
chemotherapy are as follows
(1)maintain optimal oral health.
(2)treat side effects of antineoplastic therapy.
(3)reinforce to the patient the importance of oral
health in reducing problems/discomforts arising
chemotherapy from
Post-Antineoplastic Treatment Oral
Health Care
In the post-antineoplastic treatment phase,
patients are considered cured of leukemia and not
having oral manifestations due to illness or
chemotherapy, with the exception of those with
sequelae of radiotherapy or children who received
chemotherapy in the stage of tooth formation

which may present hypoplastic areas on tooth

enamel (mineralization disorder) and changes in
the development of dental roots (which are
presented short and V-shaped(
Protecting Your Mouth
You can prevent these problems with good dental
hygiene, and there are some things you can do to
help with a sore or sensitive mouth

1-Get dental work before treatment. Because chemotherapy can

cause bleeding, it’s best to get any dental work you need you start

2-Keep up with dental appointments during

treatment. Continue to see your dentist for cleanings while you
have leukemia and during treatment to keep your mouth healthy
Protecting Your Mouth

3-Be diligent about brushing and flossing at

home. To keep your mouth in tip-top shape, brush
and floss in the morning, before bed, and after meal

4-Use gentle brushes or a sponge. Your mouth will

probably bleed more easily during chemotherapy, so
use a gentle toothbrush and take care not to cut your
gums when you floss
Protecting Your Mouth
5-Treat infections promptly. If you do develop
an infection in your mouth, be sure to see your
doctor and get treated with an antibiotic

The health of your mouth is something to take

seriously when you have leukemia, and staying
on top of your dental hygiene can prevent
problems like infection