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Pamukcu U, Dal MS, Yaman S, Aslan Candır B, Bozan E, Secilmis S, Acik Kemaloglu S, Altuntas F, Peker I. Evaluation of oral manifestations and head and neck lymphadenopathy in newly diagnosed acute leukemia patients. SPECIAL CARE IN DENTISTRY 2024; 44:911-918. [PMID: 37994175 DOI: 10.1111/scd.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/08/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES To determine the frequency of head and neck lymphadenopathy (LAP) and intraoral findings (non-dental/dental) in patients with newly diagnosed acute leukemia (AL). SUBJECTS AND METHODS Twenty-eight (52.8%) females and 25 (47.2%) males in a total of 53 patients with newly diagnosed AL with a mean age of 46 years were included in the study. Personal information, the type of AL (AML [acute myelogenous leukemia]/ALL [acute lymphocytic leukemia]), and hematological findings (anemia, neutropenia, and thrombocytopenia) were obtained from medical records. One of two calibrated oral diagnosis and maxillofacial radiology specialists performed extraoral (head and neck LAPs) and intraoral (non-dental and dental) clinical examinations. The Chi-square (χ2) test was used to evaluate categorical variables. RESULTS LAP was observed in 22.6% and intraoral findings in 30.2% of the patients. LAP was most commonly observed in the neck and none in the parotid glands. The most intraoral findings were gingival/mucosal bleeding and oral petechiae/ecchymosis. While there was no statistical difference between AML and ALL patients in terms of LAP (p > .05), intraoral findings were observed more in patients with AML (p < .05). Only two (3.8%) patients had dental findings. With a slight difference, intraoral findings were more with thrombocytopenia and LAP with neutropenia. CONCLUSION In AL, especially non-dental intraoral findings are common. The fact that dentists working in the oral cavity are often the first specialists to encounter the oral manifestations of AL imposes an important role in early diagnosis and treatment.
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Affiliation(s)
- Umut Pamukcu
- Department of Oral Diagnosis and Maxillofacial Radiology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Mehmet Sinan Dal
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Samet Yaman
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Burcu Aslan Candır
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ersin Bozan
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sema Secilmis
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sibel Acik Kemaloglu
- Department of Statistics, Faculty of Sciences, Ankara University, Ankara, Turkey
| | - Fevzi Altuntas
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ilkay Peker
- Department of Oral Diagnosis and Maxillofacial Radiology, Faculty of Dentistry, Gazi University, Ankara, Turkey
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García Rico OL, Sánchez Medina JG, Sánchez Becerra E, Cepeda Bravo JA, Tejeda Nava FJ, Rocha Viggiano AK, Salgado Bustamante M, Aranda Romo S. [Impact of acute lymphoblastic leukemia on the microbiome and oral lesions: scoping review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2023; 10:e131. [PMID: 38390612 PMCID: PMC10880714 DOI: 10.21142/2523-2754-1004-2022-131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/26/2022] [Indexed: 02/24/2024] Open
Abstract
Objective To describe the existing knowledge about the alterations of the MBO oral microbiome and the presence of OL Oral Lesions in patients with Acute Lymphoblastic Leukemia ALL. Materials and Methods An electronic search was carried out in the PubMed, SciELO, and academic Google databases, and descriptive, analytical, observational articles on MBO, OL, and ALL were included, following the PRISMA criteria. 642 were evaluated, duplicate articles, case reports, and those where only changes were reported during or after chemotherapy treatment were eliminated. Results 10 articles were evaluated, published between 1997 and 2021, 4 articles agreed that the MBO of patients with ALL is in dysbiosis showing a significant increase in firmicutes 0.1%, bacillus 0.05%, and opportunistic bacteria such as Moraxella spp, Klebsiella spp 5.66%, Pseudomonas spp 3.77%, Enterobacter spp 1.88%, Acinetobacter spp 1.88% and E. coli 1.08%, the most frequent OL reported in 5 articles were spontaneous gingival bleeding 3.5%, gingivitis 25% and ulcers 9.4%. Conclusions The oral cavity of patients with ALL is in dysbiosis and associated OL is identified. It is necessary to establish preventive strategies with a niche-ecological approach to restore the MBO, to reduce the risk of opportunistic infections and other OL during chemotherapy treatment.
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Affiliation(s)
- Olga Leticia García Rico
- Clínica de diagnóstico, Laboratorio de Bioquímica, Microbiología y PatologíaFacultad de Estomatología, Universidad Autónoma de San Luis Potosí. San Luis. Potosí, México. , , , Universidad Autónoma de San Luís Potosí Clínica de diagnóstico, Laboratorio de Bioquímica, Microbiología y Patología Facultad de Estomatología Universidad Autónoma de San Luis Potosí San Luis. Potosí Mexico
| | - Juan Gerardo Sánchez Medina
- Clínica de diagnóstico, Laboratorio de Bioquímica, Microbiología y PatologíaFacultad de Estomatología, Universidad Autónoma de San Luis Potosí. San Luis. Potosí, México. , , , Universidad Autónoma de San Luís Potosí Clínica de diagnóstico, Laboratorio de Bioquímica, Microbiología y Patología Facultad de Estomatología Universidad Autónoma de San Luis Potosí San Luis. Potosí Mexico
| | - Elizabeth Sánchez Becerra
- Clínica de diagnóstico, Laboratorio de Bioquímica, Microbiología y PatologíaFacultad de Estomatología, Universidad Autónoma de San Luis Potosí. San Luis. Potosí, México. , , , Universidad Autónoma de San Luís Potosí Clínica de diagnóstico, Laboratorio de Bioquímica, Microbiología y Patología Facultad de Estomatología Universidad Autónoma de San Luis Potosí San Luis. Potosí Mexico
| | - Juan Antonio Cepeda Bravo
- Departamento de Periodoncia Facultad de Estomatología, Universidad Autónoma de San Luis Potosí. San Luis Potosí, México. Universidad Autónoma de San Luís Potosí Departamento de Periodoncia Facultad de Estomatología Universidad Autónoma de San Luis Potosí San Luis Potosí Mexico
| | - Francisco Javier Tejeda Nava
- Departamento de Imagenología Facultad de Estomatología, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México. Universidad Autónoma de San Luís Potosí Departamento de Imagenología Facultad de Estomatología Universidad Autónoma de San Luis Potosí San Luis Potosí Mexico
| | - Ana Karenina Rocha Viggiano
- Laboratorio de epigenética, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. San Luis Potosí, México. , San Luis Potosí México
| | - Mariana Salgado Bustamante
- Laboratorio de epigenética, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. San Luis Potosí, México. , San Luis Potosí México
| | - Saray Aranda Romo
- Clínica de diagnóstico, Laboratorio de Bioquímica, Microbiología y PatologíaFacultad de Estomatología, Universidad Autónoma de San Luis Potosí. San Luis. Potosí, México. , , , Universidad Autónoma de San Luís Potosí Clínica de diagnóstico, Laboratorio de Bioquímica, Microbiología y Patología Facultad de Estomatología Universidad Autónoma de San Luis Potosí San Luis. Potosí Mexico
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Muacevic A, Adler JR, Coulibaly K, Benslima N, Youssefi H. Acute Myeloid Leukemia Revealed by a Palatal Necrosis: A Rare Case Report. Cureus 2022; 14:e32350. [PMID: 36628024 PMCID: PMC9826629 DOI: 10.7759/cureus.32350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Acute myeloid leukemia (AML) is an aggressive hematological malignancy due to genetic alterations characterized by an overproduction of neoplastic clonal myeloid stem cells in both the bone marrow and peripheral blood. We report a case of a 43-year-old man referred to the department of hematology with a three-week history of palatal pain and weakness. The physical examination revealed an ecchymosis on the left hard palatal mucosa and necrosis. The maxillofacial computerized tomography (CT) scan revealed large osteolysis of the left maxillary bone and a fistulated soft palate. The lesion's biopsy showed an acute polymorphic inflammation with no sign of malignancy. Laboratory findings revealed anemia, thrombocytopenia, elevated lactic dehydrogenase, and elevated serum ferritin. The diagnosis was subsequently confirmed by a peripheral-blood smear revealing 60% of circulating blasts and bone marrow aspiration with 80% of blast infiltration. The latter was further classified through cytogenetic studies as an AML with deletion of chromosome 7q. This case report aims to highlight the need for clinicians to be aware of palatal necrosis as an initial manifestation of the disease and to emphasize the role of multidisciplinary collaboration between dental surgeons, oral and maxillofacial surgeons, and hematologists for early detection and treatment.
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Aurora F, Arasaretnam A, Hobkirk A. The recognition of oral manifestations of haematological disease saves lives: a case report. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2022; 46:239. [PMID: 36092746 PMCID: PMC9440743 DOI: 10.1186/s42269-022-00915-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acute Leukaemias are haematological disorders characterised by the proliferation of immature white blood cells in the bone marrow and/or peripheral blood. Oral manifestations of leukaemia are common and may be the first sign of the disease. The clinical presentation of these Acute Leukaemias may include neutropenic sepsis, hyperviscocity and coagulopathy which confer a potential morbidity and mortality. Clinicians must be able to recognise this pattern of presentation. CASE REPORT We report a 34-year-old female who was referred to the Oral and Maxillofacial Surgery department with acute dental pain and pericoronitis. She subsequently had a simple dental extraction but re-presented with a bleeding socket that did not respond to local treatment. Investigation of this led to a diagnosis of Acute Promyelocytic Leukemia (APL). She was admitted under the care of the haematology team for urgent, life-saving, treatment. CONCLUSIONS Early diagnosis and treatment of the Acute Leukaemias can be life saving. The oral manifestations of disease are common and may be the first sign. Clinicians must be able to recognise this pattern of presentation and arrange urgent investigation and specialist management. CLINICAL/CPD RELEVANCE This case report discusses leukaemia and highlights the important role General Dental Practitioners can play in early diagnosis. We frame a safe approach to managing these patients in a typical case. Whilst this disease subtype is rare, the learning points can be universally applied.
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Affiliation(s)
- Fabienne Aurora
- Bristol Dental Hospital, Lower maudlin street, Bristol, BS1 2LY UK
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5
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Hamdan AA, Bouchard P, Hamdan AI, Hassona Y. Chronic lymphocytic leukemia presenting as gingival swelling and tooth mobility. SPECIAL CARE IN DENTISTRY 2021; 42:312-316. [PMID: 34766641 DOI: 10.1111/scd.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
Chronic-lymphocytic-leukemia (CLL) is the most prevalent leukemia in developed countries, caused by monoclonal proliferation of CD5+ B-cells and accumulation of mature-appearing-neoplastic lymphocytes in blood, bone marrow, and secondary lymphoid organs. Oral manifestations of CLL are infrequent and rarely reported in literature. We report a new case of a 67-year old man who presented with the complaints of tooth mobility and gingival swelling. Extra-oral examination was remarkable for cutaneous pallor and bilateral cervical lymphadenopathy involving the submandibular, and deep cervical lymph nodes on both sides of the neck. Complete blood count revealed normal red blood cell count (4.25 × 106/μl), normal platelet count (136 × 103/μl) and increased white blood cell count (25.3 × 103/μl). Differential white blood cell count showed marked lymphocytosis (88%), and blood film revealed the presence of leukocytosis, with small mature-looking lymphocytes, and mild thrombocytopenia. A flow cytometry immune-phenotyping revealed that 55% of peripheral blood cells were monoclonal B-lymphocytes expressing CD19, CD20, CD23, CD200, CD22, CD5, CD38, CD11c, sIgD and Kappa light chain confirming the diagnosis of CLL. Oral healthcare professionals should consider systemic causes, such as CLL, in the differential diagnosis of generalized tooth mobility and gingival swelling, particularly in patients with associated symptoms such as lymphadenopathy, fever, weight loss, and general fatigue.
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Affiliation(s)
- Ahmad A Hamdan
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Philippe Bouchard
- Department of Periodontology, Service of Odontology, Rothschild Hospital, Denis Diderot University, Paris, France
| | - Ahmad I Hamdan
- Department of Dentistry, The University of Jordan Hospital, Amman, Jordan
| | - Yazan Hassona
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Amman, Jordan
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Benites BM, Fonseca FP, Miranda-Silva W, Bruno JS, Tucunduva L, Fregnani ER. Myeloid sarcoma in the tongue. AUTOPSY AND CASE REPORTS 2020; 10:e2020160. [PMID: 33344279 PMCID: PMC7703000 DOI: 10.4322/acr.2020.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Leukemic cells are rarely present in the oral cavity, and there are very few reports regarding such cases. However, we identified some reports of leukemic cells infiltrating tissues in the oral cavity, including gingival involvement. Recurrent painful oral ulcerations and prominent generalized periodontal destruction are the most common oral features of neutrophil disorders, and they may even be the initial symptoms of the disease. The ulcers may affect any part of the oral mucosa, including the tongue and palate. The objective of this report is to describe and discuss a case of myeloid sarcoma in the oral cavity of a 48-year-old male patient.
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Affiliation(s)
| | - Felipe Paiva Fonseca
- Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Department of Oral Surgery and Pathology. Belo Horizonte, MG, Brazil
| | | | | | - Luciana Tucunduva
- Hospital Sírio-Libanês, Department of Onco-Hematology and Bone Marrow Transplantation. São Paulo, SP, Brazil
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7
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Rosa BPP, Ito FA, Trigo FC, Mizuno LT, Junior AT. Oral Manifestation as the Main Sign of an Advanced Stage Acute Promyelocytic Leukemia. Acta Stomatol Croat 2018; 52:358-362. [PMID: 30666067 PMCID: PMC6336446 DOI: 10.15644/asc52/4/10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Acute myeloid leukemia is an aggressive malignant neoplasm occurring mainly in elderly, with the median age of 65 years. Oral manifestations, mainly spontaneous bleeding, are a common finding in acute myelocytic leukemia and may represent the initial evidence of the disease. This report describes a case of a 47-year-old man with a one-month history of spontaneous oral bleeding. The patient had already been consulted by two professionals but he remained undiagnosed. The physical examination revealed paleness, fever, epistaxis and ecchymoses in the oral mucosa. The complete blood count revealed anemia, severe thrombocytopenia and leukocytosis with blasts predominance, reinforcing the diagnosis hypothesis of an acute leukemia. The patient was immediately referred to the Hospital and despite having received a quick intervention, he died 3 days after the admission due to diffuse pulmonary alveolar hemorrhage. According to the peripheral blood immunophenotyping the diagnosis of hypogranular variant of acute promyelocytic leukemia was established. The delay in the diagnosis may have influenced the unfavorable outcome. Early diagnosis and management are indispensable for survival of leukemia patients. In this way, dentists may be responsible for an early detection of oral manifestations of leukemia and for a fast referral to an adequate professional.
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Affiliation(s)
- Bianca Piscinato Piedade Rosa
- Departamento de Medicina Oral e Odontologia Infantil. Universidade Estadual de Londrina. Rua Pernambuco 540, Londrina-PR. Brasil
| | - Fábio Augusto Ito
- Departamento de Medicina Oral e Odontologia Infantil. Universidade Estadual de Londrina. Rua Pernambuco 540, Londrina-PR. Brasil
| | - Fausto Celso Trigo
- Departamento de Clínica Médica - Universidade Estadual de Londrina. Av. Robert Koch 60, Londrian-PR. Brasil
| | - Lauro Toyoshi Mizuno
- Departamento de Medicina Oral e Odontologia Infantil. Universidade Estadual de Londrina. Rua Pernambuco 540, Londrina-PR. Brasil
| | - Ademar Takahama Junior
- Departamento de Medicina Oral e Odontologia Infantil. Universidade Estadual de Londrina. Rua Pernambuco 540, Londrina-PR. Brasil
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8
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Aggarwal A, M Pai K. Orofacial Manifestations of Leukemic Children on Treatment: A Descriptive Study. Int J Clin Pediatr Dent 2018; 11:193-198. [PMID: 30131640 PMCID: PMC6102430 DOI: 10.5005/jp-journals-10005-1510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/28/2018] [Indexed: 11/23/2022] Open
Abstract
Aim To study the prevalence of orofacial manifestations in leukemic children undergoing treatment and to correlate these manifestations with various stages of chemotherapy. Materials and methods A prospective noninvasive study comprising 43 acute lymphocytic leukemic pediatric patients at various stages of therapy. They were examined on day of their each blood examination, and lesions were recorded on a self-designed pro forma. A total of 133 observations were recorded by a single observer. The treatment was divided into the phase of induction, consolidation, maintenance, and relapse. Results The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 10.1. There were 24 males and 19 females in this study, aged between 3 and 13 years. The common oral lesions seen were dental caries, lymphadenopathy (86.04%), pallor (65.11%), ulcers (13.95%), mucositis (16.27%), gingival enlargement, hemorrhages (20.93%), candidiasis, herpes simplex virus (HSV) infection, xerostomia (44.18%), paresthesia, and tooth mobility. Herpes simplex virus infection was seen only during induction and consolidation phases. Ulcers were seen during all phases of therapy. Clinical significance Orofacial manifestations may be seen as the first sign of leukemia and a dentist may play a significant role in the diagnosis of the disease per se. This study highlights not only about commonly occurring lesions but also their variation during various phases of therapy. To the best of our knowledge, no study has such an extensive reporting of orofacial manifestations of acute lymphocytic leukemia (ALL) patients under treatment. How to cite this article: Aggarwal A, Pai KM. Orofacial Manifestations of Leukemic Children on Treatment: A Descriptive Study. Int J Clin Pediatr Dent 2018;11(3):193-198.
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Affiliation(s)
- Aparna Aggarwal
- Reader, Department of Oral Medicine and Radiology, Maharaja Ganga Singh Dental College and Research Centre, Sri Ganganagar Rajasthan, India
| | - Keerthilatha M Pai
- Professor and Dean, Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Karnataka, India
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9
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Lupi SM, Rodriguez Y Baena A, Cervino G, Todaro C, Rizzo S. Long-Term Effects of Acute Myeloid Leukemia Treatment on the Oral System in a Pediatric Patient. Open Dent J 2018; 12:230-237. [PMID: 29760815 PMCID: PMC5897961 DOI: 10.2174/1874210601812010230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction: Acute Myeloid Leukemia (AML) in pediatric patients is a serious disease, although, for the subgroup of patients who receive proper treatment, a long-term survival rate above 50% is typical. The cycles of chemo- and radiotherapy used to treat AML can impair dental development. Case Report: Herein, we describe the oral condition of a 25-year-old male patient treated for AML with chemo- and radiotherapy from 5 to 7 years of age; his AML has remained in remission for the past 18 years. He had lost only one permanent tooth, but the remaining teeth demonstrated serious deformations and radicular hypoplasia. Two teeth required immediate extraction and subsequent replacement by implant-supported crowns. We found that the decayed, missing, filled teeth (DMFT) index was not representative of the real oral condition. Here, we report the full case and provide a brief review of the literature. Conclusion: Antitumor treatment of pediatric leukemia can induce total impairment of dental development and function. These adverse effects may become clinically evident many years after the resolution of cancer, and can be significantly detrimental to the patient’s quality of life.
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Affiliation(s)
- Saturnino Marco Lupi
- Department of Clinical, Surgical, Pediatric and Diagnostic Sciences, School of Dentistry, University of Pavia, P.le Golgi 2, 27100 Pavia , Italy
| | - Arianna Rodriguez Y Baena
- Department of Clinical, Surgical, Pediatric and Diagnostic Sciences, School of Dentistry, University of Pavia, P.le Golgi 2, 27100 Pavia , Italy
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, School of Dentistry, University of Messina, Policlinico G. Martino, Via Consolare Valeria, 98100 Messina, Italy
| | - Claudia Todaro
- Department of Clinical, Surgical, Pediatric and Diagnostic Sciences, School of Dentistry, University of Pavia, P.le Golgi 2, 27100 Pavia , Italy
| | - Silvana Rizzo
- Department of Clinical, Surgical, Pediatric and Diagnostic Sciences, School of Dentistry, University of Pavia, P.le Golgi 2, 27100 Pavia , Italy
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10
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Prevalence of oral lesions in and dental needs of patients with newly diagnosed acute leukemia. J Am Dent Assoc 2018; 149:470-480. [PMID: 29606275 DOI: 10.1016/j.adaj.2018.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 12/12/2022]
Abstract
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.
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Ratre MS, Gulati R, Khetarpal S, Parihar A. Regular oral screening and vigilance: can it be a potential lifesaver? J Indian Soc Periodontol 2018; 22:171-173. [PMID: 29769773 PMCID: PMC5939026 DOI: 10.4103/jisp.jisp_136_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Acute myeloid leukemia (AML) is a malignant neoplasm of myeloid series defined by the presence of immature blast cells (>30%) in peripheral circulation. Oral manifestations are the potential indicators of systemic health and disease. Oral cavity is the frequently and early involved sites in AML. Gingival overgrowth due to leukemia is one such condition encountered by periodontists. Hence, understanding, identifying, and correlating oral manifestations with systemic diseases are the ultimate responsibility of every dental clinician because of its lethal and unpredictable course. In the present case, we are discussing an undiagnosed case of AML who presented to us with oral complaints.
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Affiliation(s)
- Madhu Singh Ratre
- Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Ruchi Gulati
- Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Shaleen Khetarpal
- Department of Periodontology, Government College of Dentistry, Indore, Madhya Pradesh, India
| | - Ajay Parihar
- Department of Oral Medicine and Radiology, Government College of Dentistry, Indore, Madhya Pradesh, India
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Chowdhri K, Tandon S, Lamba AK, Faraz F. Leukemic gingival enlargement: A case report and review of literature. J Oral Maxillofac Pathol 2018; 22:S77-S81. [PMID: 29491612 PMCID: PMC5824525 DOI: 10.4103/jomfp.jomfp_205_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The oral cavity manifests signs of various systemic diseases. This entails thorough examination of the oral mucosa, gingiva, teeth, tongue and other oral tissues. Occasionally, oral signs can be an expression of systemic conditions such as endocrine imbalance, nutritional deficiencies and blood disorders. Leukemia is a malignancy of white blood cells, which may result in significant morbidity and mortality. Oral changes maybe the first and only presenting features in leukemia patients, making it imperative for the dentist to diagnose the disease accurately.
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Affiliation(s)
- Kanika Chowdhri
- Department of Periodontology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Shruti Tandon
- Department of Periodontology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Arundeep Kaur Lamba
- Department of Periodontology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Farrukh Faraz
- Department of Periodontology, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Gandhi K, Datta G, Ahuja S, Saxena T, G Datta A. Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy. Int J Clin Pediatr Dent 2017; 10:166-171. [PMID: 28890617 PMCID: PMC5571386 DOI: 10.5005/id-iournals-10005-1428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/29/2016] [Indexed: 11/23/2022] Open
Abstract
Multiagent chemotherapy, radiotherapy, or a combination of both are the contemporary methods of cancer treatment. With medical advancements, though cure rates have increased considerably, focus is now shifted to the potential early and late complications of the same. The aim of this study was to assess the early oral complications in pediatric patients receiving chemotherapy. Sixty-two children with cancer undergoing chemotherapy with the mean age of 7.42 ± 3.6 years were included in the study. The various types of malignancies and oral problems during chemotherapy were recorded in the subjects. The most commonly encountered malignancy was acute lymphoblastic leukemia at 35.5%. Various oral and associated complications like mucosal inflammation with ulcerations, oral pain, xerostomia, and secondary infections were commonly seen, with mucositis being the most commonly observed complication in 58.1% of the subjects undergoing chemotherapy. Clinical importance of timely medical and dental interventions by a multidisciplinary team involving a pediatric dentist at different stages of anticancer treatment is also emphasized to minimize discomfort, increase treatment compliance, and improve the quality of life of pediatric patients.
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Affiliation(s)
- Kapil Gandhi
- Professor, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Geetika Datta
- Reader, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Shilpa Ahuja
- Senior Lecturer, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Tanvi Saxena
- Senior Lecturer, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Ankush G Datta
- Ex-Senior Lecturer, Department of Orthodontics and Dentofacial Orthopedics Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
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14
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Busjan R, Hasenkamp J, Schmalz G, Haak R, Trümper L, Ziebolz D. Oral health status in adult patients with newly diagnosed acute leukemia. Clin Oral Investig 2017; 22:411-418. [PMID: 28536781 DOI: 10.1007/s00784-017-2127-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this cross-sectional study was to evaluate the oral health of adult patients with newly diagnosed acute leukemia. METHODS Patients with initially diagnosed acute myeloid (AML) or lymphocytic (ALL) leukemia and a matched healthy control (HC) group were included. The oral investigation comprised inspection of the oral mucosa; the decayed (D), missing (M), and filled (F) teeth (DMF-T) index; and a detailed periodontal status. Subgingival biofilm samples were analyzed (polymerase chain reaction) for the presence of selected potentially periodontal pathogenic bacteria. Statistical analysis was performed using Fisher's exact test, chi-squared test, and Mann-Whitney U test (significance level α = 5%). RESULTS Thirty-nine patients with leukemia (AML 26, ALL 13) and 38 HCs were included. Oral mucosal findings were present in 62% of L compared to 0% of HC patients, whereby gingival hyperplasia was the most detected finding. Furthermore, a higher caries prevalence in leukemia patients was shown (D value 3.64 ± 3.98 vs. 0.72 ± 1.72, p < 0.01). The periodontal parameters were poorer in leukemia patients. No substantial differences in microbiological findings of selected bacteria were detected within L group and between L and HC patients. CONCLUSION The high prevalence of oral diseases supports the demand of an early and consequent dental treatment of leukemia patients, especially considering subsequent therapy.
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Affiliation(s)
- Rilana Busjan
- Dept. of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany
| | - Justin Hasenkamp
- Clinic for Hematology and Medical Oncology, University of Goettingen, Goettingen, Germany
| | - Gerhard Schmalz
- Dept. of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany
| | - Rainer Haak
- Dept. of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany
| | - Lorenz Trümper
- Clinic for Hematology and Medical Oncology, University of Goettingen, Goettingen, Germany
| | - Dirk Ziebolz
- Dept. of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany.
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Francisconi CF, Caldas RJ, Oliveira Martins LJ, Fischer Rubira CM, da Silva Santos PS. Leukemic Oral Manifestations and their Management. Asian Pac J Cancer Prev 2017; 17:911-5. [PMID: 27039811 DOI: 10.7314/apjcp.2016.17.3.911] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Leukemia is the most common neoplastic disease of the white blood cells which is important as a pediatric malignancy. Oral manifestations occur frequently in leukemic patients and may present as initial evidence of the disease or its relapse. The symptoms include gingival enlargement and bleeding, oral ulceration, petechia, mucosal pallor, noma, trismus and oral infections. Oral lesions arise in both acute and chronic forms of all types of leukemia. These oral manifestations either may be the result of direct infiltration of leukemic cells (primary) or secondary to underlying thrombocytopenia, neutropenia, or impaired granulocyte function. Despite the fact that leukemia has long been known to be associated with oral lesions, the available literature on this topic consists mostly of case reports, without data summarizing the main oral changes for each type of leukemia. Therefore, the present review aimed at describing oral manifestations of all leukemia types and their dental management. This might be useful in early diagnosis, improving patient outcomes.
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Affiliation(s)
- Carolina Favaro Francisconi
- Bauru School of Dentistry, University of Sao Paulo, Department of Biological Sciences, Bauru, SP, Brazil E-mail :
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Datta G, Saxena T, Datta AG. Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy. Int J Clin Pediatr Dent 2017. [DOI: 10.5005/jp-journals-10005-1428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
ABSTRACT
Multiagent chemotherapy, radiotherapy, or a combination of both are the contemporary methods of cancer treatment. With medical advancements, though cure rates have increased considerably, focus is now shifted to the potential early and late complications of the same. The aim of this study was to assess the early oral complications in pediatric patients receiving chemotherapy. Sixty-two children with cancer undergoing chemotherapy with the mean age of 7.42 ± 3.6 years were included in the study. The various types of malignancies and oral problems during chemotherapy were recorded in the subjects. The most commonly encountered malignancy was acute lymphoblastic leukemia at 35.5%. Various oral and associated complications like mucosal inflammation with ulcerations, oral pain, xerostomia, and secondary infections were commonly seen, with mucositis being the most commonly observed complication in 58.1% of the subjects undergoing chemotherapy. Clinical importance of timely medical and dental interventions by a multidisciplinary team involving a pediatric dentist at different stages of anticancer treatment is also emphasized to minimize discomfort, increase treatment compliance, and improve the quality of life of pediatric patients.
How to cite this article:
Gandhi K, Datta G, Ahuja S, Saxena T, Datta AG. Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy. Int Int J Clin Pediatr Dent 2017;10(2):166-171.
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Abstract
Acute leukemia is the most common malignant disorder of childhood. Acute leukemia is characterized by marrow failure due to the replacement of marrow elements by leukemic blasts. Gingival hypertrophy (GH) due to acute myeloid leukemia (AML) in a child is extremely rare. Here, we report a case of AML (subtype M5 of FAB classification) in a 3-year-old male child wherein the disease primarily presented as GH.
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Affiliation(s)
- Rekha Ravikumar
- Division of Pediatric Hemato Oncology, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Rakesh Manohar
- Department of Paediatrics, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Sneha Magatha Latha
- Division of Pediatric Hemato Oncology, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Julius Xavier Scott
- Division of Pediatric Hemato Oncology, Sri Ramachandra University, Chennai, Tamil Nadu, India
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Guan G, Firth N. Oral manifestations as an early clinical sign of acute myeloid leukaemia: a case report. Aust Dent J 2015; 60:123-7. [DOI: 10.1111/adj.12272] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 12/22/2022]
Affiliation(s)
- G Guan
- Department of Oral Diagnostic and Surgical Sciences; School of Dentistry; The University of Otago; Dunedin New Zealand
| | - N Firth
- Department of Oral Diagnostic and Surgical Sciences; School of Dentistry; The University of Otago; Dunedin New Zealand
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Hasan S, Khan NI, Reddy LB. Leukemic gingival enlargement: Report of a rare case with review of literature. Int J Appl Basic Med Res 2015; 5:65-7. [PMID: 25664273 PMCID: PMC4318106 DOI: 10.4103/2229-516x.149251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/11/2014] [Indexed: 11/21/2022] Open
Abstract
Oral cavity functions as an early indicator for a variety of systemic diseases. Early and accurate diagnosis of these underlying systemic disorders entails thorough examination of the oral mucosa, gingiva, teeth, tongue and other oral tissues. Although gingival changes may be related to local factors in the oral cavity, it can also be an expression of systemic conditions such as blood dyscrasias, endocrinal imbalance, and nutritional deficiencies. Leukemia, a malignancy of white blood cells is a dreadful disease, which, if not diagnosed properly and treated early may result in significant morbidity and mortality. Oral changes may be the first and only presenting signs in leukemic patients. This paper aims to throw light on an interesting case of acute leukemia diagnosed on the basis of oral signs and emphasizes the importance of thorough oral examination to identify the threatening condition.
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Affiliation(s)
- Shamimul Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, Okhla, New Delhi, India
| | - Nabeel Ishrat Khan
- Department of Oral Medicine and Radiology, ZA Dental College and Hospitals, A.M.U., Aligarh, Uttar Pradesh, India
| | - L Bhaskar Reddy
- Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, KIIT University, Patia, Bubaneswar, Odisha, India
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Vourexakis Z. Oral lesions presenting as an early sign of acute leukaemia. BMJ Case Rep 2015; 2015:bcr-2014-205100. [PMID: 25634852 DOI: 10.1136/bcr-2014-205100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Zacharias Vourexakis
- Department of Otolaryngology/Head and Neck Surgery, University Hospital of Geneva, Geneva, Switzerland
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21
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Lim HC, Kim CS. Oral signs of acute leukemia for early detection. J Periodontal Implant Sci 2014; 44:293-9. [PMID: 25568810 PMCID: PMC4284378 DOI: 10.5051/jpis.2014.44.6.293] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/11/2014] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Systemic disease can manifest oral signs at an early phase, which may be crucial for the diagnosis and timing of treatment. This report describes two patients who presented with gingival enlargement as an early sign of acute leukemia. METHODS Two patients presented with oral symptoms including severe gingival enlargement. The progress of their symptoms was associated with underlying systemic disease. RESULTS The patients were transferred to the Department of Hematology and diagnosed with acute myelomonocytic leukemia. They received appropriate treatment and survived. CONCLUSIONS Gingival enlargement can be caused by underlying systemic diseases. Accurate diagnosis and timely referral are important for preventing a fatal situation. It must be emphasized that some oral signs and symptoms may be closely correlated with systemic diseases.
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Affiliation(s)
- Hyun-Chang Lim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Chang-Sung Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea. ; Department of Applied Life Science, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea
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22
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Babu SPKK, Kashyap V, Sivaranjani P, Agila S. An undiagnosed case of acute myeloid leukemia. J Indian Soc Periodontol 2014; 18:95-7. [PMID: 24744555 PMCID: PMC3988656 DOI: 10.4103/0972-124x.128257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 09/11/2013] [Indexed: 01/17/2023] Open
Abstract
Leukemia is a neoplastic disease characterized by an excessive proliferation of immature white blood cells and their precursors. Oral lesions may be the presenting feature of acute leukemia, which can be rapidly fatal if left untreated. Although many cases of gingival enlargement in patients with acute myeloid leukemia's have been reported in the literature, cases diagnosed by the oral manifestations in India are very few. This report describes the case of a 43-year-old female who presented with gingival bleeding and gingival enlargement. Within a month she developed signs and symptoms of systemic disease such as, and splenomegaly, and upon further investigation, she was diagnosed with acute myeloid leukemia to which she succumbed within 10 days after diagnosis. The need for early diagnosis and referral of this fatal disease are also underline.
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Affiliation(s)
- S P K Kennedy Babu
- Department of Periodontics, Mahatma Post Graduate Institute of Dental Sciences, Indira Nagar, Gorimedu, Pondicherry, India
| | - Vineet Kashyap
- Department of Periodontics, Mahatma Post Graduate Institute of Dental Sciences, Indira Nagar, Gorimedu, Pondicherry, India
| | - P Sivaranjani
- Department of Periodontics, Mahatma Post Graduate Institute of Dental Sciences, Indira Nagar, Gorimedu, Pondicherry, India
| | - S Agila
- Department of Periodontics, Mahatma Post Graduate Institute of Dental Sciences, Indira Nagar, Gorimedu, Pondicherry, India
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Gowda TM, Thomas R, Shanmukhappa SM, Agarwal G, Mehta DS. Gingival enlargement as an early diagnostic indicator in therapy-related acute myeloid leukemia: A rare case report and review of literature. J Indian Soc Periodontol 2013; 17:248-52. [PMID: 23869136 PMCID: PMC3713761 DOI: 10.4103/0972-124x.113090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 02/24/2013] [Indexed: 12/26/2022] Open
Abstract
Treatment for Hodgkin's lymphoma (HL) has resulted in excellent survival rates but is associated with increased risks of secondary therapy-related acute myeloid leukemia (t-AML). Gingival enlargement associated with bleeding and ulceration is the most common rapidly appearing oral manifestations of leukemic involvement. An 8 months pregnant patient reported with generalized gingival enlargement, with localized cyanotic and necrotic papillary areas. Co-relating the hematological report with the oral lesions and her past medical history of HL, a diagnosis of t-AML secondary to treatment for HL was made by the oncologist. As oral lesions are one of the initial manifestations of acute leukemia, they may serve as a significant diagnostic indicator for the dental surgeons and their important role in diagnosing and treating such cases. Furthermore, this case report highlights the serious complication of t-AML subsequent to HL treatment and the important role that a general and oral health care professional may play in diagnosing and treating such cases.
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Affiliation(s)
- Triveni M Gowda
- Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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24
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Kumar A, Masamatti SS, Virdi MS. Periodontal diseases in children and adolescents: a clinician's perspective part 2. ACTA ACUST UNITED AC 2012; 39:639-42, 645-6, 649-52. [DOI: 10.12968/denu.2012.39.9.639] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ashish Kumar
- Reader, Department of Periodontics, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh
| | - Sujata Surendra Masamatti
- Reader, Department of Periodontics, ITS – Centre for Dental Studies and Research, Murad Nagar, Ghaziabad, Uttar Pradesh
| | - Mandeep Singh Virdi
- Professor and Head, Department of Pedodontics and Preventive Dentistry, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India
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Yamashita Y, Isomura N, Hamasaki Y, Goto M. Case of pediatric acute promyelocytic leukemia presenting as extramedullary tumor of the mandible. Head Neck 2012; 35:E310-3. [PMID: 22972688 DOI: 10.1002/hed.23163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Acute promyelocytic leukemia (APL) is a malignant subtype of acute myeloid leukemia caused by the PML-retinoic acid receptor (RAR)α fusion gene. APL may be discovered in adulthood and diagnosed after spontaneous gingival bleeding or difficulty in hemostasis after oral surgery such as tooth extraction. However, APL is extremely rare in children. METHODS AND RESULTS A 1-year-old boy presented with a mass on the mentum of the mandible. The marked periosteal reaction was seen on CT and MRI, leading to strong suspicion of a malignant bone-derived tumor such as a sarcoma. Chromosome banding by fluorescence in situ hybridization (FISH) showed PML-RARα, confirming the diagnosis of APL. Treatment with tretinoin was immediately initiated. No signs of recurrence have been noted 1 year after treatment. CONCLUSIONS We report herein a rare case involving an infant with APL who presented with an extramedullary tumor of the mandible, whom we treated with good results.
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Affiliation(s)
- Yoshio Yamashita
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saga University, Saga, Japan
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26
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Angst PDM, Dutra DAM, Moreira CHC, Kantorski KZ. Periodontal status and its correlation with haematological parameters in patients with leukaemia. J Clin Periodontol 2012; 39:1003-10. [PMID: 22909091 DOI: 10.1111/j.1600-051x.2012.01936.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2012] [Indexed: 12/11/2022]
Abstract
AIM This cross-sectional study evaluated periodontal status in patients with leukaemia and its correlation with haematological parameters. METHODS Patients with different types of leukaemia and minimum age of 14 years were eligible. Calibrated examiners assessed Seymour index (SI), plaque index (PlI), gingival index (GI), probing depth (PD), bleeding on probing (BOP) and clinical attachment loss (CAL) and performed an interview. Haematological parameters were obtained from haemogram performed on the same day of the periodontal examinations. RESULTS Sixty-eight patients were evaluated, which corresponded to an 85% response rate. Periodontal parameters were in agreement with plaque accumulation (PlI 1.28 ± 0.5, GI 0.74 ± 0.4, PD 2.27 ± 0.6, BOP 33%, CAL 2.31 ± 1.6). PlI and CAL were statistically lower in acute leukaemia (1.13 ± 0.61 and 1.96 ± 1.7) in comparison with chronic leukaemia (1.46 ± 0.44 and 2.74 ± 1.4). Moreover, older age (95% confidence interval [CI]: 0.27-1.56), higher educational level (CI: -1.94 to -0.64) and smoker (CI: 0.39-1.96) were associated with CAL. Correlation between periodontal and haematological parameters was not observed. Correlations between GI x SI and PD x SI were statistically significant (r(S) = 0.390, p = 0.001; r(S) = 0.517, p = 0.000 respectively). CONCLUSIONS Periodontal parameters were consistent with plaque accumulation and did not correlate with haematological parameters irrespective of the leukaemia type.
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Angst PDM, Dutra DAM, Moreira CHC, Kantorski KZ. Gingival inflammation and platelet count in patients with leukemia: preliminary results. Braz Oral Res 2011; 25:544-9. [DOI: 10.1590/s1806-83242011000600012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 10/10/2011] [Indexed: 11/22/2022] Open
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28
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Suárez-Cuenca JA, Arellano-Sánchez JL, Scherling-Ocampo AA, Sánchez-Hernández G, Pérez-Guevara D, Chalapud-Revelo JR. Rapidly progressing, fatal and acute promyelocytic leukaemia that initially manifested as a painful third molar: a case report. J Med Case Rep 2009; 3:102. [PMID: 19946580 PMCID: PMC2783043 DOI: 10.1186/1752-1947-3-102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Accepted: 11/03/2009] [Indexed: 11/21/2022] Open
Abstract
Introduction Acute promyelocytic leukaemia, an uncommon and devastating subtype of leukaemia, is highly prevalent in Latin American populations. The disease may be detected by a dentist since oral signs are often the initial manifestation. However, despite several cases describing oral manifestations of acute promyelocytic leukaemia and genetic analysis, reports of acute promyelocytic leukaemia in Hispanic populations are scarce. The identification of third molar pain as an initial clinical manifestation is also uncommon. This is the first known case involving these particular features. Case presentation A 24-year-old Latin American man without relevant antecedents consulted a dentist for pain in his third molar. After two dental extractions, the patient experienced increased pain, poor healing, jaw enlargement and bleeding. A physical examination later revealed that the patient had pallor, jaw enlargement, ecchymoses and gingival haemorrhage. Laboratory findings showed pancytopaenia, delayed coagulation times, hypoalbuminaemia and elevated lactate dehydrogenase. Splenomegaly was detected on ultrasonography. Peripheral blood and bone marrow analyses revealed a hypercellular infiltrate of atypical promyelocytic cells. Cytogenetic analysis showing genetic translocation t(15;17) further confirmed acute promyelocytic leukaemia. Despite early chemotherapy, the patient died within one week due to intracranial bleeding secondary to disseminated intravascular coagulation. Conclusion The description of this unusual presentation of acute promyelocytic leukaemia, the diagnostic difficulties and the fatal outcome are particularly directed toward dental surgery practitioners to emphasise the importance of clinical assessment and preoperative evaluation as a minimal clinically-oriented routine. This case may also be of particular interest to haematologists, since the patient's cytogenetic analysis, clinical course and therapeutic response are well documented.
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Affiliation(s)
- Juan A Suárez-Cuenca
- Department of Internal Medicine, Ticomán General Hospital, SSDF Mexico City, Mexico
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29
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Bakathir AA, Al-Hamdani AS. Relapse of acute lymphoblastic leukemia in the jaw. ACTA ACUST UNITED AC 2009; 107:e14-6. [DOI: 10.1016/j.tripleo.2009.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2008] [Revised: 01/21/2009] [Accepted: 01/21/2009] [Indexed: 10/20/2022]
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30
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Kinane DF, Peterson M, Stathopoulou PG. Environmental and other modifying factors of the periodontal diseases. Periodontol 2000 2006; 40:107-19. [PMID: 16398688 DOI: 10.1111/j.1600-0757.2005.00136.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Denis F Kinane
- University of Louisville School of Dentistry, Kentucky, USA
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31
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Dean AK, Ferguson JW, Marvan ES. Acute leukaemia presenting as oral ulceration to a dental emergency service. Aust Dent J 2003; 48:195-7. [PMID: 14640374 DOI: 10.1111/j.1834-7819.2003.tb00032.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Leukaemia is a neoplastic disease characterized by an excessive proliferation of immature white blood cells and their precursors. Oral lesions may be the presenting feature of acute leukaemias, which can be rapidly fatal if left untreated. This report describes the case of a 22-year-old female who presented to a dental emergency department with oral manifestations of acute leukaemia. It outlines the role of oral lesions in the diagnosis of acute leukaemias and emphasizes the importance of immediate referral by general dental practitioners.
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Affiliation(s)
- A K Dean
- School of Dental Science, The University of Melbourne, Victoria
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32
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Ishikawa I. Re: Er: YAG laser scaling of diseased root surfaces. Frentzen M, Braun A, Aniol D. (2002;73;524-530). J Periodontol 2002; 73:1227; author reply 1227-8. [PMID: 12416782 DOI: 10.1902/jop.2002.73.10.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wu J, Fantasia JE, Kaplan R. Oral manifestations of acute myelomonocytic leukemia: a case report and review of the classification of leukemias. J Periodontol 2002; 73:664-8. [PMID: 12083541 DOI: 10.1902/jop.2002.73.6.664] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Oral signs and symptoms may indicate a serious underlying systemic disease. The most frequently observed oral findings of leukemia are mucosal bleeding and ulceration, petechiae, and gingival hyperplasia. This case report describes a 53-year-old male who presented with gingival enlargement and bleeding, fatigue, and recent weight loss as initial manifestations of acute myelomonocytic leukemia. METHODS A gingival biopsy was performed, revealing the presence of a hypercellular infiltrate of atypical myeloid and monocytic cells. Further work-up consisted of a complete blood count, bone marrow biopsy, and immunohistochemical and histochemical analysis of biopsy material and flow cytometry of peripheral blood. RESULTS Flow cytometry results confirmed that the infiltrate was of a myelomonocytic origin, and a diagnosis of acute myelomonocytic leukemia was rendered. The patient responded well to a chemotherapeutic induction regimen of cytosine arabinoside and idarubicin hydrochloride, with regression of gingival enlargement and remission of disease. The patient continued with consolidation chemotherapy and an autologous bone marrow transplant, but eventually died 22 months after initial diagnosis. CONCLUSIONS Oral health care professionals, especially periodontists, must recognize that gingival enlargement may represent an initial manifestation of an underlying systemic disease. Acute myelogenous leukemia is a hematological disorder with a predilection for gingival involvement.
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Affiliation(s)
- Josephine Wu
- Department of Dental Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA
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Abstract
Clinical observation of our patients forms the basis of the dental examination, along with other more complex diagnostic tests. In this case, the gingival bleeding episode of one patient was initially diagnosed and treated as an acute periodontal episode. When simple therapy failed to resolve the bleeding, a full haematological investigation was ordered. This revealed the presence of a life-threatening disease. The patient was immediately referred for medical management of acute myeloblastic leukaemia, but died some months later. Dentists should always be on guard to observe any unusual clinical signs that may lead to the early diagnosis of systemic disease processes.
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35
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Abstract
Microbial dental plaque is the initiator of periodontal disease but whether it affects a particular subject, what form the disease takes, and how it progresses, are all dependent on the host defenses to this challenge. Systemic factors modify all forms periodontitis principally through their effects on the normal immune and inflammatory defenses. Some good examples of this effect exist such as when there is a reduction in number or function of polymorphonuclear leukocytes (PMNs) that may result in an increased rate and severity of periodontal destruction. Many other systemic factors are much less clear cut and are difficult to causally link to periodontitis. In many cases the literature is insufficient to make definite statements on links between systemic factors and periodontitis. It is also at times difficult to be precise regarding the causative agent in systemic exposures such as smoking and even prescribed drug therapy. The possible role of systemic diseases and systemic exposures in initiating or modifying the progress of periodontal disease is clearly a complex issue. It is however generally agreed that several conditions may give rise to an increased prevalence, incidence, or severity of gingivitis and periodontitis. The categorization of the systemic modifying factors causing periodontitis and the evidence to support the role of these factors are the focus of this review. An attempt has been made to consider the conditions under broad headings, but it will be clear that many conditions fall within more than one category and that for several conditions only case reports exist whereas in other areas an extensive literature is present.
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Affiliation(s)
- D F Kinane
- Glasgow Dental Hospital and School, Department of Adult Dental Care, Scotland
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36
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Affiliation(s)
- D Kinane
- Department of Oral Medicine and Pathology, Glasgow Dental Hospital and School, Scotland, UK
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37
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Abstract
OBJECTIVE To evaluate in detail the oral complications of leukemia at initial presentation. Associations between oral manifestations and laboratory data were also investigated. STUDY DESIGN A retrospective study of 230 cases was conducted to investigate the nature and incidence of oral manifestations at initial presentation. The following data were determined for each patient: age, sex, haemogram at diagnosis (which included haemoglobin, red blood cell counts, differential white blood cell counts, platelet counts), classification of the type of leukemia's systemic symptoms and oral manifestations at the initial physical examination including the dental consultation. RESULTS It was revealed that the type of leukemia diagnosed, except with CML, is related to the age prediliction of patients. The incidence of leukemia is higher in males than in females. The most common manifestations of leukemia are lymphadenopathy (71.4% in ALL; 45% in AML), laryngeal pain (52.7% in ALL; 37.3% in AML), gingival bleeding (43.2% in AML; 28.6% in ALL), oral ulceration, and gingival enlargement. Fever (92.2%) was the most common symptom in patients with all types of leukemia. Platelet counts from 25,000 mm-3 to 60,000 mm-3 are at sufficiently low levels to result in spontaneous bleeding. Most of the patients had WBC counts of greater than 10,000 mm-3. Only 12.6% of patients had normal WBC counts. CONCLUSIONS It was concluded that the age prediliction and prevalence of oral manifestations are closely related to the type of leukemia.
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Affiliation(s)
- G L Hou
- Graduate Institute of Dental Sciences, School of Dentistry, Kaohsiung Medical College, Taiwan, Kaohsiung, Taiwan
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38
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Kleinheinz J, Meyer U, Büchner T, Kösters G, Weingart D, Joos U. [Oral manifestations of acute leukemia]. MUND-, KIEFER- UND GESICHTSCHIRURGIE : MKG 1997; 1:57-60. [PMID: 9483931 DOI: 10.1007/bf03043510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
It is well known that non-specific mucosal alterations can occur during diseases of the leukopoetic system. In most cases they are an early sign and therefore provide the opportunity for timely diagnosis of the disease. In this clinical study type and frequency of oral lesions, gingival and periodontal indices, and hematologic status were examined at the time of diagnosis of the different types of acute leukemia. The results showed a significant difference in the frequency of oral lesions between acute myelogenous and acute lymphoblastic forms, irrespective of age and sex of the patient. There was no correlation between type and frequency of lesions and hematologic status.
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Affiliation(s)
- J Kleinheinz
- Klinik und Poliklinik für Mund- und Kiefer-Gesichtschirurgie, Westfälische-Wilhelms-Universität, Münster
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39
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Anil S, Smaranayake LP, Nair RG, Beena VT. Gingival enlargement as a diagnostic indicator in leukaemia. Case report. Aust Dent J 1996; 41:235-7. [PMID: 8870276 DOI: 10.1111/j.1834-7819.1996.tb04865.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The acute leukaemias are a group of neoplastic diseases that are characterized by proliferation of immature white cells in the bone marrow and/or blood and are often associated with severe leukopenia, anaemia and thrombocytopenia. Oral manifestations are more common in patients with acute leukaemia. Oral bleeding, gingival enlargement, ulceration and infection in patients with leukaemia have been described. Leukaemic infiltrates in the gingivae are commonly seen in acute monocytic leukaemia. A case of acute monocytic leukaemia in a 34-year-old female who reported with gingival enlargement is presented here. The role of oral lesions as a diagnostic indicator is discussed.
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Affiliation(s)
- S Anil
- Department of Periodontics, Government Dental College, Trivandrum, India
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40
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Sheller B, Williams B. Orthodontic management of patients with hematologic malignancies. Am J Orthod Dentofacial Orthop 1996; 109:575-80. [PMID: 8659466 DOI: 10.1016/s0889-5406(96)70068-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
More than 50% of pediatric malignancies are leukemias or lymphomas. Oral changes associated with these conditions include: gingival oozing, petechiae, hematomas, ulcerations, gingival pain, gingival hypertrophy, mucosal pallor, pharyngitis, and lymphadenopathy. Current medical management for patients with hematologic malignancies includes chemotherapy, radiation, surgery, bone marrow transplantation or a combination of these modalities. Nearly 60% of patients diagnosed today with malignancy will be long-term survivors. Patients undergoing orthodontic treatment when a diagnosis of malignancy is made are best served by expedient removal of orthodontic appliances and delivery of retainers. After a patient has completed all cancer therapy and has at least a 2-year event-free survival, orthodontic treatment can be restarted.
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Affiliation(s)
- B Sheller
- University of Washington, Seattle, USA
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41
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O'Sullivan EA, Duggal MS, Bailey CC, Curzon ME, Hart P. Changes in the oral microflora during cytotoxic chemotherapy in children being treated for acute leukemia. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 76:161-8. [PMID: 8361725 DOI: 10.1016/0030-4220(93)90198-d] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Thirty-four children with diagnosed cases of acute leukemias and being treated with cytotoxic chemotherapy at St James' Hospital, Leeds, were followed for between 6 months and 1 year to determine the changes in their oral microflora. They were examined before treatment commenced and then at monthly intervals. Swabs were taken from the oral cavity to test for the presence or absence of bacteria and Candida. Saliva samples were also used to assess the levels of Streptococcus mutans in the mouth. Sensitivity tests were carried out to assess the effect of the cytotoxic agents on the oral flora. All children received prophylactic nystatin and chlorhexidine gluconate mouthrinses four times daily for the whole period of the study. There was significant difference (p < 0.0001) for counts of S. mutans at different treatment stages. Sensitivity tests showed that S. mutans was sensitive to the cytotoxic drug daunorubicin, and this drug was probably responsible for the fall in S. mutans counts. A significant difference was also found in the types of bacteria isolated between the study and reference groups, but there was no change in the composition of the flora in the study group during treatment. These bacteria were also found to mirror those cultured from routine blood samples in children with acute leukemia.
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Affiliation(s)
- E A O'Sullivan
- Division of Child Dental Health, Leeds Dental Institute, United Kingdom
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42
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Green JG, Durham TM. Application of INSTAT hemostat in the control of gingival hemorrhage in the patient with thrombocytopenia. A case report. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1991; 71:27-30. [PMID: 1825236 DOI: 10.1016/0030-4220(91)90515-e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Gingival bleeding in the patient with thrombocytopenia can be a difficult management problem. Primary therapy with platelet transfusions may not be sufficient to control the hemorrhage and adjunctive local therapy may be required. Currently, few local management techniques can effectively control this problem. INSTAT collagen absorbable hemostat can be used as a local adjunct with platelet transfusions and has certain application advantages over topical thrombin and microfibrillar collagen. Two successful techniques of INSTAT application to control gingival hemorrhage in a patient with severe thrombocytopenia in leukemic relapse are described.
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Affiliation(s)
- J G Green
- Department of Pathology, Diagnosis and Radiology, University of Nebraska Medical Center College of Dentistry
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43
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Brenneise CV, Mattson JS, Commers JR. Acute myelomonocytic leukemia with oral manifestations: report of case. J Am Dent Assoc 1988; 117:835-7. [PMID: 3204244 DOI: 10.14219/jada.archive.1988.0125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A patient seeking dental care was diagnosed with acute myelomonocytic leukemia and referred to a hematologic-oncologic service for confirmation and treatment. The typical oral findings and a discussion of the disease process of acute leukemia are presented.
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Affiliation(s)
- C V Brenneise
- Department of Oral Diagnosis and Radiology, School of Dentistry, Creighton University, Omaha, NB 68178
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44
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Hou GL, Tsai CC. Primary gingival enlargement as a diagnostic indicator in acute myelomonocytic leukemia. A case report. J Periodontol 1988; 59:852-5. [PMID: 3225733 DOI: 10.1902/jop.1988.59.12.852] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A 25-YEAR-OLD CHINESE FEMALE, five months pregnant, came to our dental clinic with a chief complaint of slight gingival inflammation. A diagnosis of pregnancy gingivitis was made. One week later, there was a sudden onset of extremely generalized gingival enlargement and very high WBC count (144,000/cmm) was noted. Physical, laboratory, and microscopic examination led to the diagnosis of acute myelomonocytic leukemia. The observations of good oral hygiene and clinical course suggested that leukemic cell infiltration was the major cause of sudden onset of gingival enlargement. This article emphasizes the importance of primary gingival enlargement in the initial diagnosis of leukemia.
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Affiliation(s)
- G L Hou
- Department of Periodontics, School of Dentistry, Kaohsiung Medical College, Taiwan, R.O.C
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45
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Abstract
This report documents a case of a patient presenting unusual oral features of one of the rarer variants of acute nonlymphocytic leukemia, a malignancy whose oral manifestations may be the first indication of the presence of an underlying blood dyscrasia. The findings at the initial appointment and the patient's progress for the following 13 months until his death are presented. Initial suspicion of the clinical symptoms and an immediate, subsequent hospital hematology report established the diagnosis. The histologic features of a gingival biopsy taken during the oral examination were strongly suggestive of leukemia. Since the leukemias may imitate other oral conditions, especially various diseases of the periodontium, it is of paramount importance that the dental clinician recognize their clinical manifestations. As future treatment modalities improve, the dental clinician is seeing more leukemic patients in remission as well as more cases that have relapsed.
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Affiliation(s)
- B N Appel
- Diagnostic Services, University of Pittsburgh School of Dental Medicine, PA 15261
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46
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Cale AE, Freedman PD, Lumerman H. Acute promyelocytic leukemia appearing as spontaneous oral hemorrhage: report of case. J Am Dent Assoc 1988; 116:671-2. [PMID: 3259958 DOI: 10.14219/jada.archive.1988.0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Oral signs and symptoms may often signify a serious underlying systemic disease. This case report describes a 45-year-old Oriental male with spontaneous oral hemorrhage and submucosal bullae of 4 days' duration. These oral findings represent the initial manifestations of acute promyelocytic leukemia. An aggressive postdiagnostic course was taken; however, the patient died 8 days after the diagnosis was established.
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Affiliation(s)
- A E Cale
- Booth Memorial Medical Center, Oral Pathology Lab, Inc, Flushing, NY 11355
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47
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48
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Abstract
The oral signs and symptoms of acute leukemia include gingival hypertrophy, gingival hemorrhage, petechiae and ecchymoses, mucosal ulceration, paresthesia, tooth pain, and oral infections. This case was unusual in that the diagnosis of acute leukemia was made only after a biopsy specimen of tissue protruding from the socket of a recently extracted tooth disclosed malignant cells suggestive of leukemia or lymphoma. The diagnosis of epulis granulomatosa should be made only after clinical, radiographic, and microscopic studies have been performed to rule out a malignant process.
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49
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Gordon MR, O'Neal RB, Woodyard SG. A variation from classic oral manifestations associated with acute myeloblastic leukemia. A case report. J Periodontol 1985; 56:285-7. [PMID: 3859635 DOI: 10.1902/jop.1985.56.5.285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A case representing previously misdiagnosed acute myeloblastic leukemia associated with an absence of classical intraoral manifestations is presented. Platelet count was less than 15,000, and hematocrit was 20.3, yet clinical signs were limited to malaise and extreme gingival and mucosal pallor. The typical initial signs of gingival enlargement or hemorrhage never appeared, probably due to excellent plaque control by this patient. Mucosal color changes dictated the need for laboratory studies leading to a rapid and relatively early diagnosis.
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50
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Abstract
A classification of gingival lesions that may be encountered in the patient with acute leukemia during remission induction chemotherapy and following bone marrow transplantation is presented. The classification distinguishes between lesions resulting directly from the disease and treatment, and those resulting indirectly from the depression of normal bone marrow and lymphoid tissues.
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