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Sometimes, the first signs of leukaemia can appear in unexpected areas of the body.
We’ve previously looked at how small bleeds behind the eye known as “Roth spots” can be detected during a routine eye test to help prompt an early diagnosis of leukaemia. In addition to microscopic changes in the eyes, minor changes in the mouth such as bleeding gums (gingival bleeding), a rash of small purple spots (petechiae), or a pale and ulcerated inner lining of the mouth can be indicative of leukaemia.
In this blog we take a look at how an unsuspecting trip to the dentist could be a crucial first step in detecting the first symptoms of leukaemia.
“My dentist actually worked in the hospital. I think he’s saved two or three people. If it wasn’t for him, I wouldn’t be here today.”
The oral signs of leukaemia
There are a range of oral symptoms that, when spotted by your dentist, will hopefully prompt them to schedule you in for a blood test with your local GP. If any of the following symptoms apply to you, we advise booking an appointment with your dentist or GP.
Sometimes you may notice that your gums start to bleed when you bite into a hard food (such as an apple) or when you spit after brushing your teeth. Bleeding gums can be caused by anything from brushing too hard, gum disease (gingivitis), or very occasionally leukaemia.
Nevertheless, if your gums continue to bleed, this is a sign that something is not right. By booking an appointment with your dentist, they will be able to tell you what is causing the bleeding or will refer you to a doctor if they are concerned.
“I was constantly bleeding from the mouth and there were bruises all over my body.”
Bruising of the roof of your mouth or inside your cheeks is perhaps harder to spot on your own. Bruises may be dark and large, or they might occur as a rash of small, red or purple spots (petechiae). Sometimes bruises and rashes are only noticeable under the proper lighting of a dentist’s chair. If petechiae rash is spotted by your dentist, they will alert you and will ask you to book a GP appointment to find out the cause.
An increase in the size of the gums (known as gingival hyperplasia) is reported as a symptom in a small portion of leukaemia patients. The gum around the teeth will look swollen with inspection and you might feel a tightness in your mouth.
Although swollen gums are normally a sign of poor oral hygiene, sometimes leukaemia 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.
Ulcers are the result of infections inside the mouth. Therefore, they are more likely to occur in people with weakened immune systems, such as those with leukaemia. In leukaemia, the immune system is weakened because the healthy white blood cells that help us to fight infections are crowded out by cancerous blood cells. Ulcers occur when bacteria (often from tooth plaque) gets into little cuts inside the mouth and causes it to become infected. Since the mucous membrane inside the mouth is constantly exposed to the air and various foods, it provides an easy route for the infection to enter.
The NHS recommends visiting your dentist or GP if mouth ulcers last longer than three weeks or they keep reappearing.
“I was experiencing very painful gums and mouth ulcers, so went to see a dentist.”
In addition to checking your gums and mouth, your dentist will also inspect your neck, jaw and lymph nodes (found just underneath your jaw line) for any abnormal swelling or suspicious lumps. Enlarged lymph nodes or glands can be felt as lumps in the neck, and they are a common first symptom of leukaemia. They can arise when abnormal lymphocytes build up in the lymph nodes in the throat, armpits or groin. The lumps are not usually painful, making them harder to spot.
“I discovered a lump in my neck too, which my GP picked up on straightaway and sent me to hospital.”
If an abnormal lump is found by your dentist, they will tell you to contact your GP or an appropriate medical professional.
How often should I be visiting my dentist?
How regularly you should be attending your dentist ultimately depends on how good your oral health is. Your dentist will suggest when your next appointment is needed, which can range anywhere from three months to two years depending on the condition of your teeth and gums.
However, the most important thing is that you don’t hesitate to book an appointment with your dentist if you do start to notice anything unusual. Don’t wait to see if it will go away.
“I had a sore mouth, but we were going on holiday on a cruise, so I asked the dentist if he would take a couple of teeth out for me.
They came out very easily, but he said, ‘Your mouth’s not right, there’s something wrong here.”
For information on the other symptoms of leukaemia, click here.