Hemorrhage may occur during treatment-induced thrombocytopenia and/or coagulopathy and is a concern for patients who are receiving high-dose chemotherapy or undergoing hematopoietic stem cell transplantation. Spontaneous gingival oozing may occur when platelet counts drop below 20,000/mm3, especially when there is preexisting gingivitis or periodontitis. Even normal function or routine oral hygiene (brushing and flossing) can induce gingival oozing in the face of preexisting gingivitis and periodontitis.
Although rarely serious, oral bleeds can be of concern to the patient and family. Oral bleeding may be mild (e.g., petechiae located on the lips, soft palate, or floor of the mouth) or severe (e.g., persistent gingival hemorrhage or bleeding from herpes simplex virus ulcers in the face of severe thrombocytopenia).
"Selected Vegetables" and "Sun's Soup " are different mixtures of vegetables and herbs that are being studied as treatments for people with cancer (see Question 1).
Dried and frozen forms of Selected Vegetables are sold in the United States as dietary supplements (see Question 1).
The vegetables and herbs in Selected Vegetables/Sun's Soup may contain substances that block the growth of cancer cells and/or help the body's immune system kill cancer cells (see Question 2).
It is not uncommon for oncology patients to be told specifically to not use toothbrushes and dental floss when their platelet counts drop below 40,000/mm3. This is generally poor advice unless there are extenuating circumstances. Healthy gingival tissues do not bleed unless traumatized. Discontinuation of routine oral hygiene can increase the risk of infection that could not only promote bleeding but also increase the risk of local and systemic infection due to accumulation of bacterial plaque, leading to periodontal infections and tissue breakdown. Such issues further support the utility of pre–cancer therapy dental treatments to reduce or eliminate gingival or periodontal conditions.
The degree of health professional oversight of thrombocytopenic patients is an important consideration relative to risk of mechanical hygiene procedures. With comprehensive monitoring, patients can often safely use dental brushing and flossing throughout the thrombocytopenic episode. Foam brushes are recommended by some practitioners. However, studies have shown that foam brushes cannot adequately remove dental plaque along gingival margins, thus promoting gingival infection and bleeding.
Management of oral bleeds revolves around the use of vasoconstrictors, clot-forming agents, and tissue protectants: