Vol 13, No 2 (2022)
Case report
Published online: 2022-10-20

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Oral manifestations of leukaemia: cooperation between dentist and haematologist

Ewa Michalak1, Agata Dudzik1, Joanna Śręba1, Barbara Kęsek1, Dagmara Darczuk1
Hematology in Clinical Practice 2022;13(2):55-61.


Many systemic diseases can manifest in the oral mucosa. Leukaemia is the most common neoplastic disease of white blood cells. Common symptoms of leukaemia in the oral cavity include mucosa pallor, bleeding gums, gingival enlargement, ecchymosis, oral infections and ulcerations. A dentist should know how to recognize the first signs of leukaemia and may be responsible for a prompt referral to an adequate professional to improve patient outcomes. A dentist must participate in a patient’s process of treatment when the plan includes complex therapy of the oral cavity. In many cases, this procedure enables the implementation of appropriate therapy and the possibility of recovery and can even save the patient’s life.

The study aimed to present the cooperation between the dentist and haematologist in the example of a 52-year-old female with oral symptoms of leukaemia.

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  1. Dmoszyńska A, Robak T, Hus I. Podstawy hematologii. Wydanie III. Wydawnictwo Czelej, Lublin. ; 2015: 227–270.
  2. Wysocka-Słowik A, Dorocka-Bobkowska B, Gil L. Ostra białaczka szpikowa w praktyce lekarza dentysty. Dent Forum. 2016; 44(1): 97–102.
  3. Wetzler M, Byrd JC, Bloomfield CD. Ostra i przewlekła białaczka szpikowa. Onkologia i Hematologia. 2009; 6(104): 738–742.
  4. Francisconi CF, Caldas RJ, Oliveira Martins LJ, et al. Leukemic oral manifestations and their management. Asian Pac J Cancer Prev. 2016; 17(3): 911–915.
  5. Deliverska E, Krasteva A. Oral Signs of leukemia and dental management – literature data and case report. Journal of IMAB - Annual Proceeding (Scientific Papers). 2013; 19(4): 388–391.
  6. Zimmermann C, Meurer MI, Grando LJ, et al. Dental treatment in patients with leukemia. J Oncol. 2015; 2015: 571739.
  7. López-Valverde N, López-Valverde A, Gómez-de Diego R, et al. Gingival hyperplasia as an early manifestation of acute myeloid leukemia. A retrospective review. J Clin Exp Dent. 2019; 11(12): e1139–e1142.
  8. Cammarata-Scalisi F, Girardi K, Strocchio L, et al. Oral manifestations and complications in childhood acute myeloid leukemia. Cancers (Basel). 2020; 12(6).
  9. Lupi SM, Rodriguez Y Baena A, Cervino G, et al. Long-Term effects of acute myeloid leukemia treatment on the oral system in a pediatric patient. Open Dent J. 2018; 12: 230–237.
  10. Chowdhri K, Tandon S, Lamba AK, et al. Leukemic gingival enlargement: A case report and review of literature. J Oral Maxillofac Pathol. 2018; 22(Suppl 1): S77–S81.
  11. Ratre MS, Gulati R, Khetarpal S, et al. Regular oral screening and vigilance: can it be a potential lifesaver? J Indian Soc Periodontol. 2018; 22(2): 171–173.
  12. Chapple ILC, Mealey BL, Van Dyke TE, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018; 89 Suppl 1: S74–S84.
  13. Shankarapillai R, Nair MA, George R, et al. Periodontal and gingival parameters in young adults with acute myeloid leukaemia in Kerala, South India. Oral Health Prev Dent. 2010; 8(4): 395–400.
  14. Zwaan CM. van den Heuvel-Eibrink MM. Pediatric acute myeloid leukemia. In: Antica M. ed. Acute leukemia — the scientist’s perspective and challenge. InTech, London 2011: 235–276.
  15. Maloney KW, Giller R, Hunger SP. Recent advances in the understanding and treatment of pediatric leukemias. Adv Pediatr. 2012; 59(1): 329–358.
  16. Misirlioglu M, Adisen MZ, Yilmaz S. Diagnosis of acute myeloid leukemia in a dental hospital; report of a case with severe gingival hypertrophy. Niger J Clin Pract. 2015; 18(4): 573–576.
  17. Dean AK, Ferguson JW, Marvan ES. Acute leukaemia presenting as oral ulceration to a dental emergency service. Aust Dent J. 2003; 48(3): 195–197.
  18. Singh-Rambiritch S, Wood NH. Post-chemotherapeuticresolution of acute myeloid leukaemia-induced gingivalenlargement: a case report. SADJ. 2012; 67(7): 344–347.
  19. Busjan R, Hasenkamp J, Schmalz G, et al. Oral health status in adult patients with newly diagnosed acute leukemia. Clin Oral Investig. 2018; 22(1): 411–418.
  20. Lauritano D, Petruzzi M. Decayed, missing and filled teeth index and dental anomalies in long-term survivors leukaemic children: a prospective controlled study. Med Oral Patol Oral Cir Bucal. 2012; 17(6): e977–e980.
  21. Allareddy V, Prakasam S, Allareddy V, et al. Poor Oral Health Linked with Increased Risk of Infectious Complications in Adults with Leukemia. J Mass Dent Soc. 2015; 64(3): 38–42.
  22. Djuric M, Hillier-Kolarov V, Belic A, et al. Mucositis prevention by improved dental care in acute leukemia patients. Support Care Cancer. 2006; 14(2): 137–146.
  23. Ellegaard B, Bergmann OJ, Ellegaard J. Effect of plaque removal on patients with acute leukemia. J Oral Pathol Med. 1989; 18(1): 54–58.
  24. McGaw W, Belch A. Oral complications of acute leukemia: Prophylactic impact of a chlorhexidine mouth rinse regimen. Oral Surgery, Oral Medicine, Oral Pathology. 1985; 60(3): 275–280.
  25. Reenesh M, Munishwar S, Rath SK. Generalised leukaemic gingival enlargement: a case report. J Oral Maxillofac Res. 2012; 3(3): e5.
  26. Lupi SM, Rodriguez Y Baena A, Cervino G, et al. Long-Term Effects of Acute Myeloid Leukemia Treatment on the Oral System in a Pediatric Patient. Open Dent J. 2018; 12: 230–237.
  27. Wang Y, Zeng X, Yang X, et al. Oral health, caries risk profiles, and oral microbiome of pediatric patients with leukemia submitted to chemotherapy. Biomed Res Int. 2021; 2021: 6637503.
  28. Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, et al. Prevention and Treatment of Chemotherapy and Radiotherapy Induced Oral Mucositis. Medicina (Kaunas). 2019; 55(2).
  29. Kashiwazaki H, Matsushita T, Sugita J, et al. Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation. Support Care Cancer. 2012; 20(2): 367–373.
  30. Bradstock KF, Link E, Collins M, et al. Australasian Leukaemia and Lymphoma Group. A randomized trial of prophylactic palifermin on gastrointestinal toxicity after intensive induction therapy for acute myeloid leukaemia. Br J Haematol. 2014; 167(5): 618–625.
  31. Kazemian A, Kamian S, Aghili M, et al. Benzydamine for prophylaxis of radiation-induced oral mucositis in head and neck cancers: a double-blind placebo-controlled randomized clinical trial. Eur J Cancer Care (Engl). 2009; 18(2): 174–178.
  32. Rastogi M, Khurana R, Revannasiddaiah S, et al. Role of benzydamine hydrochloride in the prevention of oral mucositis in head and neck cancer patients treated with radiotherapy (>50 Gy) with or without chemotherapy. Support Care Cancer. 2017; 25(5): 1439–1443.
  33. Sheibani KM, Mafi AR, Moghaddam S, et al. Efficacy of benzydamine oral rinse in prevention and management of radiation-induced oral mucositis: A double-blind placebo-controlled randomized clinical trial. Asia Pac J Clin Oncol. 2015; 11(1): 22–27.
  34. Wong KH, Kuciejewska A, Sharabiani MTA, et al. A randomised controlled trial of Caphosol mouthwash in management of radiation-induced mucositis in head and neck cancer. Radiother Oncol. 2017; 122(2): 207–211.
  35. Murdock JL, Reeves DJ. Chemotherapy-induced oral mucositis management: A retrospective analysis of MuGard, Caphosol, and standard supportive care measures. J Oncol Pharm Pract. 2020; 26(3): 521–528.
  36. Vokurka S, Bystricka E, Scudlova J, et al. The risk factors for oral mucositis and the effect of cryotherapy in patients after the BEAM and HD-l-PAM 200 mg/m(2) autologous hematopoietic stem cell transplantation. Eur J Oncol Nurs. 2011; 15(5): 508–512.
  37. Bardy J, Molassiotis A, Ryder WD, et al. A double-blind, placebo-controlled, randomised trial of active manuka honey and standard oral care for radiation-induced oral mucositis. Br J Oral Maxillofac Surg. 2012; 50(3): 221–226.
  38. Hewlings S, Kalman D. A review of zinc-l-carnosine and its positive effects on oral mucositis, taste disorders, and gastrointestinal disorders. Nutrients. 2020; 12(3).
  39. Szałek E. Zapalenie błony śluzowej jamy ustnej — istotny problem terapeutyczny w onkologii. Farmacja Współczesna. 2018; 11: 8–14.
  40. Sahebjamee M, Mansourian A, Hajimirzamohammad M, et al. Comparative efficacy of aloe vera and benzydamine mouthwashes on radiation-induced oral mucositis: a triple-blind, randomised, controlled clinical trial. Oral Health Prev Dent. 2015; 13(4): 309–315.
  41. Stawarz-Janeczek M, Szczeklik K, Pytko-Polończyk J. Oral mucositis (OM) — a common problem for oncologists and dentists. Nowotwory J Oncol. 2020; 70: 253–259.
  42. Guo H, Seixas-Silva JA, Epperly MW, et al. Prevention of radiation-induced oral cavity mucositis by plasmid/liposome delivery of the human manganese superoxide dismutase (SOD2) transgene. Radiat Res. 2003; 159(3): 361–370.
  43. Manoharan V, Fareed N, Battur H, et al. Effectiveness of mouthrinses in prevention and treatment of radiation induced mucositis: A systematic review. J Cancer Res Ther. 2020; 16(Suppl): S1–S10.
  44. Rahn R, Adamietz IA, Boettcher HD, et al. Povidone-iodine to prevent mucositis in patients during antineoplastic radiochemotherapy. Dermatology. 1997; 195 Suppl 2: 57–61.
  45. Etiz D, Erkal HŞ, Serin M, et al. Clinical and histopathological evaluation of sucralfate in prevention of oral mucositis induced by radiation therapy in patients with head and neck malignancies. Oral Oncol. 2000; 36(1): 116–120.
  46. Majdaeen M, Babaei M, Rahimi A. Sodium bicarbonate containing mouthwash for preventing radiotherapy-induced oral mucositis in patients with locally advanced head and neck cancer. Rep Radiother Oncol. 2015; 2(2).