Swollen Gums: A Sign of Leukemia and Importance of Oral Health During Cancer Treatment

The Link Between Swollen Gums and Cancer

Swollen gums can be caused by a variety of factors, ranging from gingivitis to medication side effects. However, persistent gum swelling may also be a sign of a more serious underlying condition, such as cancer.

Leukemia, a cancer of the blood and bone marrow, is one type of cancer that can lead to swollen gums. The high numbers of abnormal white blood cells seen in leukemia can infiltrate gum tissues, leading to inflammation, reddening, and swelling.

How Leukemia Causes Swollen Gums

Leukemia prevents the bone marrow from producing normal blood cells. Instead, the bone marrow produces abnormal immature white blood cells, called leukemic blast cells.

These leukemic blast cells fail to function properly and accumulate in the blood, taking up space where normal white blood cells, red blood cells, and platelets should be. As the number of blast cells increases, the numbers of normal blood cell counts decline.

This leads to anemia, increased risk of infection, and issues with blood clotting. The uncontrolled growth of white blood cells can also infiltrate other tissues beyond the blood and bone marrow, including the gums.

When leukemic cells invade gum tissue, it triggers inflammation and swelling of the gums. Gum swelling may come and go but tends to get progressively worse as leukemia advances.

Other Oral Symptoms of Leukemia

Along with gum swelling, leukemia can cause other oral health issues including:

• Bleeding gums
• Mouth sores
• Infections
• White patches or plaques in the mouth
• Jaw pain
• Tooth decay

These symptoms occur because leukemia reduces normal white blood cell counts, impairing the body's ability to fight infections. The dysfunction and underproduction of platelets also impairs normal blood clotting.

As a result, people with leukemia are more susceptible to bleeds, mouth sores, and infections from things like bacteria and fungi. The high cell turnover seen in leukemia can also lead to the development of ulcers and white plaques in the mouth.

When to See a Doctor

Occasional gum swelling from things like food injury or flossing too hard is likely not a cause for concern on its own. However, if you notice your gums are chronically inflamed or swollen, it is important to see a dentist.

Your dentist can examine your gums and mouth and determine if there is gum disease or another dental issue that requires treatment. If your dentist rules out dental causes, they may recommend you follow up with your physician for further testing.

See your physician promptly if you have any of the following:

• Ongoing gum swelling for more than 2 weeks
• Bleeding gums when brushing or flossing
• Frequent mouth sores
• Slow healing mouth wounds
• Unexplained tooth pain or loose teeth
• White spots, patches, or ulcerations in mouth
• Unexplained jaw pain

A doctor can order blood tests to check your cell counts for signs of leukemia or other blood cancers. A physical exam may also reveal symptoms like swollen lymph nodes, bruising, fever, bone pain, and fatigue.

Understanding Leukemia Treatment

There are four main types of leukemia, which include:

• Acute lymphoblastic leukemia (ALL)
• Chronic lymphocytic leukemia (CLL)
• Acute myeloid leukemia (AML)
• Chronic myeloid leukemia (CML)

Treatment options can include chemotherapy, radiation therapy, immunotherapy, and stem cell transplants. The goal is to get the leukemia into remission by killing off abnormal cells.

Side Effects of Leukemia Treatment

Leukemia treatment, particularly chemotherapy, often causes side effects that can further impact oral health. Common side effects include:

• Mouth sores
• Infections
• Gum swelling
• Tooth decay
• Dry mouth
• Jaw pain
• Ulcers
• Bleeding

Chemotherapy works by killing fast dividing cells. Unfortunately, it cannot differentiate between cancer cells and healthy cells. This means it also kills fast dividing cells in the mouth, gut, and hair follicles leading to side effects.

The steroids in chemotherapy regimes also increase susceptibility to infections, which can further impact the gums and oral cavity.

Caring for Your Mouth During Treatment

It is important to pay close attention to your oral health when undergoing leukemia treatment. Make sure to:

• Brush teeth gently after meals and before bed with a soft bristle brush.
• Floss once a day, again gently.
• Use an alcohol-free mouthwash.
• Drink lots of water and stay hydrated.
• Avoid irritants like tobacco, alcohol, spicy food, and caffeine.
• Check mouth daily for sores and swelling. Tell your doctor about any oral changes.
• Suck on ice chips or sugar-free popsicles before and after chemo to minimize mouth sores.
• Avoid crunchy, acidic, salty, and sugary foods that can irritate the mouth.

Your oncologist may also recommend medication to coat and soothe the mouth and gums during cancer treatment.

The Importance of Regular Dental Care

It is vital for people with leukemia to maintain excellent oral hygiene and see the dentist for cleanings and checkups every 3-4 months.

Reduce Infection Risk

Due to the dysfunction in normal white blood cell production, leukemia patients are immunocompromised and at high risk of developing infections, including oral infections.

Seeing the dentist for regular dental cleanings can remove plaque and bacteria, reducing chances of infection. People with leukemia are also advised to take preventive antibiotics prior to certain dental procedures to further decrease infection risks.

Monitor for Oral Cancer

Oral cancer screenings by a dentist are imperative for leukemia patients, as the chemotherapy and radiation therapy increases long-term risks of oral cancer development.

Dentists can carefully inspect the mouth, tongue, gums, and throat for signs of abnormal growths or changes that require biopsy. Any oral cancer detected early affords the best chance for successful treatment.

Manage Oral Side Effects

Checking in regularly with the dentist allows close monitoring of potential leukemia treatment related side effects. From gum swelling to mouth sores and infections, the dentist has multiple tools to manage symptoms.

Medicated mouth rinses, fluoride treatments, soft diet counseling, and pain medication can help minimize oral health impacts during cancer therapy.

Outlook for Leukemia Patients

The prognosis for leukemia patients has improved significantly over past decades thanks to advances in treatments. Therapy can achieve long-term remission, during which the person can lead a normal active life.

Work Closely With Your Oncology & Dental Team

Managing leukemia requires close coordination between your oncology and dental teams. Make sure your dentist knows your diagnosis, treatment regimen, and any oral side effects you experience.

Your oncologist also needs to know about oral health issues that arise. With good communication, your doctors can work together to minimize complications and keep your mouth as healthy as possible.

Oral Care Optimizes Treatment Effectiveness

Paying attention to oral hygiene and care optimizes leukemia treatment effectiveness. Oral infections and issues can otherwise lead to breaks in treatment and chemotherapy dose reductions.

Keeping your mouth clean, seeing the dentist regularly, and managing any side effects provides the best environment for the therapies to work.

There Are Things You Can Do

While leukemia therapy brings about many side effects outside personal control, maintaining good oral hygiene and care is something you can control. This includes brushing, flossing, hydration, mouth rinses, and seeing the dentist.

Though oral issues may still arise, you will know you took active steps to optimize your mouth health during leukemia treatment.

In addition to medical therapies, a healthy engaged outlook and support system provide the best means of coping with the diagnosis. There are many reasons to be hopeful when facing leukemia, especially with today's treatment options.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.