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Bleeding gums is a common manifestation in leukaemia, more so in acute leukaemias like Acute Myeloid leukaemia (AML) and Acute Lymphoblastic leukaemia (ALL). It has a tendency to mirror underlying hematologic abnormalities and can sometimes be one of the initial symptoms of a cancer. Not every bleeding gum is cancer—but sometimes, in limited instances, they are the earliest detectable sign of leukaemia. Dr Priyanka Tikoo, BDS, MDS And Founder, Dantvedya Dental Clinic, Gaur City Centre, Delhi NCR, explains the causes, prevention and the signs to look out for if your gum bleeding is serious or not:
Signs to Watch Out For
According to Dr Tikoo, more often than not, gum bleeding happens as a result of poor dental hygiene or a bruise, or at times when one brushes too hard. However cytopenia (a medical condition characterized by a lower-than-normal number of blood cells in the peripheral blood) and gum-bleeding need urgent medical attention if:
- Bleeding is spontaneous and recurring
- Associated with tiredness, bruising, or infection
- Not due to brushing pressure or plaque
Causes Of Gum Bleeding
Dr Tikoo enlists reasons as to why someone might develop frequent gum bleeding in case of leukaemia.
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Low Platelet Count (Thrombocytopenia)
Platelets play an important role in blood clotting.Malignant cells accumulate in the bone marrow, lowering normal platelet production. Symptoms include bleeding gums, petechiae, and bruising.
Neutropenia & Immunosuppression
Low neutrophils make patients susceptible to infection and contribute to or aggravates gingivitis (inflammation of the gums)or periodontitis (damage of soft tissue and bone that support your teeth) from compromised defenses.
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Leukemic Infiltration
Primarily in AML, leukemic cells infiltrate gum tissue and can potentially cause hypertrophy, redness, and spontaneous bleeding.
Coagulopathies
Disorders of clotting such as disseminated intravascular coagulation (in APL) also cause spontaneous bleeding.
Why Do Gums Bleed In Leukaemia?
Leukaemia hinders the bone marrow's production of:
Platelets (for clotting)
White blood cells (to fight infection)
Red blood cells (to carry oxygen)
When platelets decrease, even minor trauma (such as brushing) can result in ongoing bleeding. AML can cause gum invasion by abnormal cells, resulting in swelling, bleeding, and pain.
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Treatment Approach
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According to Dr Priyanka, leukaemia must be treated with a multi-faceted approach. The first concern is to attack the cancer itself—most often with chemotherapy, which is the norm for most acute leukaemias. Certain specific leukaemias, such as Acute Promyelocytic leukaemia (APL), are treated with specialized regimens like ATRA. In patients who are high-risk or in relapse, stem cell transplantation could be indicated. Bleeding is controlled with platelet transfusions when the count falls precariously low, and with drugs such as tranexamic acid to control mucosal bleeding. Avoid aspirin and other painkillers. The oral cavity is important: the use of a soft toothbrush, antiseptic mouthwash, and pain-relieving gels can be used to guard sensitive tissues. Dental treatment should be delayed until the platelet count can be raised. Finally, if there is an infection or fever, physicians can begin antibiotics or antifungals early to avert complications.
Conclusion
More often than not bleeding gums are common and harmless and could be gotten rid of with proper oral hygiene and brushing slightly carefully. However, that might not always be the case. Sometimes, if it is frequent, it could be a sign of cancer or other serious illness. And hence, it is highly advised to get your teeth or gums checked if you experience bleeding regularly.