Patients with undiagnosed leukemia may first seek care from the dentist. In these individuals, oral symptoms are among the earliest common complaints. There is a direct relationship between low platelet counts and increased episodes of serious bleeding from the gum in these patients; platelet transfusions proved effective in checking bleeding. It was also noticed that fever and septicemia predisposed to serious bleeding with rapid utilization of platelets and poor survival of transfused platelets. Thus, more frequent transfusions are needed in such clinical situations, also as prophylaxis.
The oral changes start with a reddening of the inside of the mouth observed at the end of the first week of treatment By the middle of the second week, white patches appear on the lining (mucosa) of the lips, cheeks and tongue. The irritation becomes progressively more severe week by week. A sloughing of the mucosa occurs by the third week, and by the 4th and 5th week, the lips and corners of the mouth have an ulcerated appearance. The mucosa may become very painful, the discomfort being so severe that the patient resists chewing and swallowing.
Alkaline mouthwash to which a large spoonful of milk of magnesia is added, gives some relief. Rinsing of the mouth with topical xylocaine before meals, may help the patient to eat. Another effect of radiation therapy is the severe depression of salivary secretion, leading to marked, persistent and irreversible sensation of dryness of the mouth”. The dosage required to produce it, has been reported as 1500 rads to 2000 rads. The time required to produce the condition has been reported as early as at 2 to 6 hours after radiation to up to 3 weeks.