Leukemic Oral Manifestations and their Management

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.

Gingival leukemic infiltration as the first manifestation of acute myeloid leukemia

“…Mouth can exhibit the first sign of leukemia through mucosal pallor, spontaneous bleeding, petechial hemorrhages, oral ulcerations and enlargement of gingiva, including recurrent viral, bacterial and fungal infections combined or solely. 4,7,12 These oral manifestations may be the direct result of the infiltration of leukemic cells or secondary to underlying thrombocytopenia, neutropenia, or impaired granulocyte function. 7,13 Gingival hyperplasia occurs more frequently in AML, 7 involving subtypes acute monocytic leukemia (M5; 66.7%), acute myelomonocytic leukemia (M4) (18.5%) and acute myelocytic leukemia (M1, M2) (3.7%).…”

“…5 Patient with AML may present with anemia, neutropenia, thrombocytopenia, weakness, easy fatigue, fever, bone pain, infections, bleeding, gingival enlargement, petechiae, ecchymosis, mucosal pallor, and oral ulceration. 3,4,6,7 Leukemic infiltration of the gums can be the first sign of leukemia and the recognition of this is important for early diagnosis of the disease and prognosis. [1][2][3][4][5][6][7][8][9][10][11] This report describes a young girl with AML and whose complaints were confined to gingival overgrowth and bleeding.…”

“…3,4,6,7 Leukemic infiltration of the gums can be the first sign of leukemia and the recognition of this is important for early diagnosis of the disease and prognosis. [1][2][3][4][5][6][7][8][9][10][11] This report describes a young girl with AML and whose complaints were confined to gingival overgrowth and bleeding. This was the first clinical manifestation of the disease and the dentist was responsible for the diagnosis.…”

Intra‐oral noma‐like lesion associated with acute myeloid leukaemia: a case report

“…Acute myeloid leukaemia ordinarily includes intra‐oral symptoms in some stage of the disease. It is well established that the oral symptoms can precede the general medical symptoms.…”

Trismus as an Orofacial Manifestation of Acute Lymphoblastic Leukemia

“…It is classified depending on clinical course of disease (acute or chronic) and the primary hematopoietic cell line affected (myeloid or lymphoid). 1) Leukemia is often associated with orofacial manifestations, and these manifestations may occur due to direct leukemic cell infiltration of tissues, or be secondary to underlying anemia, thrombocytopenia, neutropenia and impaired granulocyte function.…”