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Teeth with a bleeding risk: gentle and careful

When platelets are low, gums bleed easily. Mouth care must not stop, because infection risk rises, but the method needs to be gentler.

Last updated: ~1 min read
Toothbrushes with soft bristles in a clear glass
Figure 1.The softest brush

01Short answer

Soften an extra-soft brush further in warm water and brush with slow movements. If platelets are very low, your team may suggest foam swabs and rinses instead of a brush. Pause floss, interdental brushes and water flossers until your team allows them. Use an alcohol-free rinse. Plan dental treatment such as extractions or cleaning with your team. If bleeding does not stop within 10 to 15 minutes, call.

02Simple explanation

Soften the brush.

Floss: pause.

Dentist: with your team.

Will not stop: call.

03Scientific explanation

NCI: with thrombocytopenia, an extra-soft brush should be used, and flossing only with your team's approval.

NCI: chemotherapy can lower neutrophils, platelets and red cells, which raises the risk of infection, bleeding and fatigue.

04What happens in the body?

Gums

Rich in tiny vessels and sensitive to injury.

Plaque

Plaque left in place increases gum inflammation and bleeding.

Neutrophils

The first defence against infection; when they are low, hygiene matters most.

Platelets

Help blood clot; when they are low, protect yourself from injury.

05Daily protection: four steps

Wash, protect, check, report.

Wash — Hands and personal hygiene.1WashHands and personal hygiene.
Protect — Against injury and infection.2ProtectAgainst injury and infection.
Check — Temperature and skin.3CheckTemperature and skin.
Report — Tell your team about changes.4ReportTell your team about changes.
HygieneClean hands.
TemperatureThe 38 °C threshold.
ProtectionYour team's rules.

06Key points at a glance

TopicIn brief
GumsRich in tiny vessels and sensitive to injury.
PlaquePlaque left in place increases gum inflammation and bleeding.
NeutrophilsThe first defence against infection; when they are low, hygiene matters most.
PlateletsHelp blood clot; when they are low, protect yourself from injury.

07Key terms

Gingivitis
Inflammation of the gums.
Plaque
A layer of bacteria on the teeth.
ANC
Absolute neutrophil count.
Thrombocytopenia
A low platelet count.

08Key points

  • Soften.
  • Brush slowly.
  • Rinse.
  • Wash your hands.
  • 38 °C: call.

09Frequently asked questions

My gums bleed when I brush.

Rinse with cool water, press with gauze and tell your team.

I have toothache.

Do not treat it yourself; your team will involve a dentist.

What should I watch every day?

Temperature, bleeding, tiredness and the catheter site; tell your team about any change.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. My gums bleed when I brush.

  2. I have toothache.

  3. What should I watch every day?

My questions

12Sources

  1. National Cancer Institute. Mouth and Throat Problems and Cancer Treatment
  2. National Cancer Institute. Infection and Neutropenia during Cancer Treatment
  3. National Cancer Institute. Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment
  4. National Cancer Institute. Anemia and Cancer Treatment
  5. World Health Organization. World Hand Hygiene Day
  6. Cancer Research UK. Chemotherapy safety at home
  7. Macmillan Cancer Support. Supporting someone with cancer
  8. NHS (UK). Support and benefits for carers
  9. CA: A Cancer Journal for Clinicians, 2010. Interventions with family caregivers of cancer patients: meta-analysis of randomized trials
  10. Cancer, 2016. Caring for caregivers and patients: Research and clinical priorities for informal cancer caregiving
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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