Prevalence of oral lesions in and dental needs of patients with newly diagnosed acute leukemia.

BACKGROUND

Dentists are generally taught that in a significant number of patients with newly diagnosed acute leukemia (NDAL), the diagnosis may be suspected based on oral signs. In this study, the authors determined the frequency of oral signs of leukemia and tabulated the clinical dental needs and hematologic aspects of these patients.

METHODS

Four calibrated dentists performed clinical examinations in 263 consecutive patients with NDAL. A standardized data form was used to direct and record presence or absence of oral signs of leukemia, clinically apparent dental disease, and circulating blood counts.

RESULTS

Oral signs of leukemia were detected on oral examination in 30.8% (95% confidence interval [CI], 25.2% to 36.4%) of patients with NDAL on examination. Only 5.7% (95% CI, 2.9% to 8.5%) of patients had gingival enlargement (GE). Although 33.7% (95% CI, 26.6% to 40.9%) of regular dental treatment seekers and 55.3% (95% CI, 45.3% to 65.4%) of nonregular dental treatment seekers had clinically detectable dental disease, only 18.6% (95% CI, 13.9% to 23.3%) had circulating blood counts that precluded all but urgent oral health care.

CONCLUSION

Although 30.8% of patients examined had some oral sign of leukemia, most adults with NDAL do not have GE at the initial examination. Even patients receiving regular oral health care may have unmet dental needs at the initial assessment that could safely be addressed before treatment.

PRACTICAL IMPLICATIONS: Dentists should not necessarily expect to be able to detect overt oral signs of leukemia, such as GE, in patients with NDAL on oral examination. Once patients receive the diagnosis, dentists may be able to safely eliminate dental disease in most patients in an appropriate setting. Dentists are encouraged to undertake a thorough review of systems.