Gingival enlargement in al is either due to leukemic infiltration, or due to reactive hyperplasia. Oral bleeding, gingival enlargement, ulceration and infection in patients with leukemia have been described. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Acute myeloid leukemia aml is a malignancy of the hematopoietic progenitor cells that provokes bleeding and fever as a result of infection1. Gingival enlargement associated with systemic diseases many systemic diseases can develop oral manifestations that may include gingival enlargement these systemic diseases andor conditions can affect the periodontium by two different mechanisms as follows. May 22, 2014 gingival enlargement in leukemia occurs due to infiltration of premature leukocytes.
Histological and immunohistochemical features of gingival. However, patients are apt to avoid oral care out of fear of the pain and hemorrhage associated with. Typical oral manifestations of acute leukemia include gingival swelling, oral ulceration, spontaneous gingival bleeding. Gingival enlargement, leukemia, oral manifestations. Gingival enlargement observed in acute leukemia is due to.
Additional instructions and trouble shooting are included with the game. Differential diagnoses of inflammatory gingival enlargement, acute leukemia, acute necrotizing ulcerative gingivitis anug and human. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues.
On evaluation, he was found to have gingival hyperplasia. Unusual clinical presentation of generalized gingival. Gingival hyperplasia is a rare finding in clinical practice. The clinical examination revealed gingival enlargement and expansion of alveolar mucosa particularly in molar regions of both jaws. A case of diffuse gingival enlargement in acute myeloblastic leukemia aml m1 jadhav varsha sukhdeo1, jadhav avinash sukhdeo2, singhal kapil3 tuteja neeraj4 1mds, junior resident, department of periodontology and oral implantology, govt dental college and.
Gingival enlargement in leukemia occurs due to infiltration of premature leukocytes. Prescription of calcium channel blockers is relatively common, making it difficult to determine the true incidence of druginduced gingival enlargement. Gingival hyperplasia is secondary to infiltration of the gingival tissue with leukemia cells and is well described in the literature. Acute monocytic leukemia, acute myeloid leukemia, gingival enlargement, immunophenotyping. Primary gingival enlargement as a diagnostic indicator in. To differentiate between them a biopsy is required, but being highly contraindicated, biopsy has been substituted in. Gingival enlargement as oral manifestation in acute myeloid.
Unusual clinical presentation of generalized gingival free download as powerpoint presentation. Severe alveolar bone loss and gingival hyperplasia as initial. Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. Identifying gingival overgrowth as an initial oral manifestation of leukemic infiltration is extremely important for establishing an early diagnosis of acute leukemia. The main symptoms are fatigue, weight loss, fever and gingival bleeding. Introduction gingival enlargement is a common feature of gingival disease and may be caused by fibrous overgrowth or gingival inflammation or a combination of two. Gingival enlargement gingival enlargement or overgrowth is usually caused by local inflammatory conditions such as poor oral hygiene, food impaction, or mouth breathing. We report a case of a patient who presented with gingival enlargement secondary to leukaemic infiltration. Management of gingival hyperplasia associated with sore. Gingival hyperplasia is most commonly seen with the aml subtypes acute monocytic leukemia m5 and acute myelomonocytic leukemia m4. The patient had only five teeth, all poorly conserved. Gum hypertrophy warning sign of acute myeloblastic. A case of diffuse gingival enlargement in acute myeloblastic.
Among the oral manifestations, gingival hyperplasia is frequently encountered by patients with aml. A 21 year old male presented with fever, weakness and petechiae. Although many cases of gingival enlargement in patients with acute myeloid leukemia have been reported in. The present case is a 19yearold male who was referred for further management of stage 5 chronic kidney disease. Unusual clinical presentation of generalised gingival enlargement.
Abstract most of the systemic diseases manifest signs and symptoms in oral cavity. In addition, fibrotic gingival enlargement has been reported and is believed to be the result of a genetic predisposition for example hereditary or familial gingival enlargement. The myelodysplastic syndrome mds is characterized by peripheral blood cytopenias and increased risk of transformation to acute myeloid leukemia. Leukemic gingival enlargement a role of periodontist in. The oral manifestations of leukaemia include gingival enlargement, oral ulcerations, gingival bleeding, petechia and mucosal pallor. Gingival fine needle aspiration cytology in acute leukemia. This is a common symptom that aids in the diagnosis of leukemia and warrants dental consultation. A case of a 19yearold male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here. Oral lesions occur in both acute and chronic form of all types of leukaemias. These are strictly clinical descriptive terms and they avoid the erroneous pathologic connotations of terms of terms used in the past, such as hypertrophic and gingival hyperplasia.
A case of gingival enlargement in acute myeloid leukemia. Leukemic gingival enlargement leukemic enlargement occurs in acute or subacute. The function of the compensating curve is the effects of plaque on vascularity of the gingival connective tissue result in 1. Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. Gingival enlargement and its treatment authorstream. Management of druginduced gingival enlargement australian. Gingival hyperplasia can be seen in patients with familial gingival enlargement, pregnancy and leukemia. Leukemic infiltrates in the gingivae are commonly seen in acute monocytic leukemia. Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. Gingival hyperplasia as an early manifestation of acute. Pdf gingival enlargement as oral manifestation in acute. Gingival enlargement is one of the frequent features of gingival diseases.
Extramedullary involvement of leukemia can occur in up to 40% of patients. Aug 12, 2010 in some pathological conditions, gingivitis caused by plaque accumulation can be more severe, with the result of an overgrowth. Case report anil, s smaranayake, lakshman p nair, raj g beena, v. Gingival enlargement observed in acute leukemia is due to vitality tests are used to differentiate between median anterior maxillary cysts occur in the ameloblastomas originate from the it is possible to misdiagnose the midline palatal suture as a the lamina dura is if the image of a supernumerary tooth appears in a second radiograph to have. Systemically related gingival enlargements include, but are not limited to, scurvy, leukemia, puberty, pregnancy, multisystem syndromes and selected drugs andor agents. Gingival hyperplasia complicating acute myelomonocytic leukemia. Evaluation of medical history revealed that the patient was under chemotherapy for 1 year ending 5 months before, for a curetted mole which had appeared. Large infiltration of chronic lymphocytic leukemia in the. One week later, there was a sudden onset of extremely generalized gingival enlargement and very high wbc count 144,000cmm was noted. Chronic inflammatory gingival enlargement associated with. Gingival hyperplasia as an early diagnostic oral manifestation in. Physical, laboratory, and microscopic examination led to the diagnosis of acute myelomonocytic leukemia. Uniquely, this patient was well enough to allow full periodontal examination and incisional gingival biopsy to be performed both before and after chemotherapy.
Magnification of an existing inflammation initiated by dental plaque 2. Drug induced gingival enlargement by rajesh hosadurga. In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. 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. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both.
The symptoms include gingival enlargement and bleeding, oral ulceration, petechia, mucosal pallor. Gingival enlargement is an increase in the size of the gingiva gums. Nevertheless, the overgrowth involves the gingival margin with extension to the interdental papilla. In some pathological conditions, gingivitis caused by plaque accumulation can be more severe, with the result of an overgrowth. There are several causes of gingival enlargement and they can be grouped into four categories. Case report gingival enlargement as a diagnostic indicator in leukaemia. Phenytoin is an anticonvulsant which is seen to cause gingival enlargement in human patients with a reported incidence of 50%. Gingival enlargement an overview sciencedirect topics. While the radiographs showed severe alveolar bone loss which extended to apical thirds of many teeth, the microbiologic analysis revealed that the. Gingival infiltration in acute monoblastic leukaemia. Almost all teeth had deep periodontal pockets and severe mobility. Gingival hyperplasia in acute leukemia stanford medicine 25.
Oral signs of leukemia and dental management literature. Recently it is known that gingival overgrowth may be a consequence of the administration of three groups of medicaments anticonvulsants 2, calcium channel blockers. Here, we discuss the pathophysiology of leukemiaassociated gingival enlargement based on a case of acute myelomonocytic leukemia amlm4 with typical gingival enlargement. Gingival enlargement is a prominent symptom in patients with myelomonocytic leukemia amlm4 and acute monocytic leukemia amlm5. At this moment the patient presented hemoglobin level of 14.
One of the main drugs associated with go is the antiepileptic. This syndrome affects blood cell production and behavior. Gingival infiltration of leukemic cells is most commonly seen in acute monocytic leukemia m5 and acute myelomonocytic leukemia m4. Amlodipineinduced gingival hyperplasia in a young male with. A 46 years old male, a known case of chronic myeloid leukemia reported with gum enlargement since 2 months. One of the rarest sites of extramedullary involvement is the oral cavity, with only 5% or less of all patients with aml present with gum infiltration. Jun, 2012 gingival hypertrophy in a patient of acute biphenotypic leukemia. The lesion may involve the interproximal spaces, and become so extensive that the teeth are displaced and their crowns covered.
Here, an unusual case of diffuse gum hypertrophy in a 25 year old asian female which led to laboratory studies yielding a rapid and relatively early diagnosis of acute myeloblastic leukemia aml m2 was reported. Systemic conditions such as hormonal changes, drug therapy, or tumor infiltrates may also cause or contribute to the severity of gingival enlargement. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. Gingival hyperplasia in acute leukemia stanford medicine. Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611. Leukemic infiltrates in the gingiva are commonly seen in acute leukemia. Mds is difficult to diagnose because of the absence of symptoms in the early stage of the disease. The enlargement can be inflammatory,fibrotic or a combination of both. However, patients are apt to avoid oral care out of fear of the pain and hemorrhage associated with the myelopoietic disorder. Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. Gingival hypertrophy in a patient of acute biphenotypic leukemia.
Nevertheless, when it occurs, it is a finding of great value as it can lead to definite clinical diagnosis. Aug 12, 2014 gingival enlargement associated with systemic diseases many systemic diseases can develop oral manifestations that may include gingival enlargement these systemic diseases andor conditions can affect the periodontium by two different mechanisms as follows. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Oral findings in acute leukemia al are common and could be the presenting feature of the disease, namely, gingival enlargement, ulceration, bleeding, and infection. Nov 10, 2007 we report a case of a patient who presented with gingival enlargement secondary to leukaemic infiltration. Primary gingival enlargement as a diagnostic indicator in acute myelomonocytic leukemia.
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