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. Gingival hyperplasia as an early diagnostic oral manifestation in. Systemic conditions such as hormonal changes, drug therapy, or tumor infiltrates may also cause or contribute to the severity of gingival enlargement. Almost all teeth had deep periodontal pockets and severe mobility. In some pathological conditions, gingivitis caused by plaque accumulation can be more severe, with the result of an overgrowth. Phenytoin is an anticonvulsant which is seen to cause gingival enlargement in human patients with a reported incidence of 50%.
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. 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. However, patients are apt to avoid oral care out of fear of the pain and hemorrhage associated with the myelopoietic disorder. Surgical treatment of gingival overgrowth with 10 years of. The oral manifestations of leukaemia include gingival enlargement, oral ulcerations, gingival bleeding, petechia and mucosal pallor. Recently it is known that gingival overgrowth may be a consequence of the administration of three groups of medicaments anticonvulsants 2, calcium channel blockers. Gingival enlargement, leukemia, oral manifestations. Aug 12, 2010 in some pathological conditions, gingivitis caused by plaque accumulation can be more severe, with the result of an overgrowth. Oral signs of leukemia and dental management literature. Gingival hyperplasia as an early manifestation of acute. Nevertheless, when it occurs, it is a finding of great value as it can lead to definite clinical diagnosis. 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.
The enlargement can be inflammatory,fibrotic or a combination of both. Gingival hyperplasia can be seen in patients with familial gingival enlargement, pregnancy and leukemia. This syndrome affects blood cell production and behavior. The patient had only five teeth, all poorly conserved. Gingival enlargement and its treatment authorstream. A case of diffuse gingival enlargement in acute myeloblastic. Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. Amlodipineinduced gingival hyperplasia in a young male with. Physical, laboratory, and microscopic examination led to the diagnosis of acute myelomonocytic leukemia. Gingival hyperplasia in acute leukemia stanford medicine 25.
Leukemic infiltrates in the gingiva are commonly seen in acute leukemia. Gingival enlargement as oral manifestation in acute myeloid. 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 gingival enlargement or overgrowth is usually caused by local inflammatory conditions such as poor oral hygiene, food impaction, or mouth breathing. Systemically related gingival enlargements include, but are not limited to, scurvy, leukemia, puberty, pregnancy, multisystem syndromes and selected drugs andor agents. Leukemic gingival enlargement leukemic enlargement occurs in acute or subacute. The clinical examination revealed gingival enlargement and expansion of alveolar mucosa particularly in molar regions of both jaws. Oral findings in acute leukemia al are common and could be the presenting feature of the disease, namely, gingival enlargement, ulceration, bleeding, and infection. The lesion may involve the interproximal spaces, and become so extensive that the teeth are displaced and their crowns covered. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician.
Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. This is a common symptom that aids in the diagnosis of leukemia and warrants dental consultation. While the radiographs showed severe alveolar bone loss which extended to apical thirds of many teeth, the microbiologic analysis revealed that the. Pdf gingival enlargement as oral manifestation in acute. Unusual clinical presentation of generalised gingival enlargement. However, patients are apt to avoid oral care out of fear of the pain and hemorrhage associated with. Acute myeloid leukemia aml is a malignancy of the hematopoietic progenitor cells that provokes bleeding and fever as a result of infection1. We report a case of a patient who presented with gingival enlargement secondary to leukaemic infiltration. Gingival hyperplasia complicating acute myelomonocytic leukemia.
Gingival hyperplasia is a rare finding in clinical practice. Gingival hyperplasia is most commonly seen with the aml subtypes acute monocytic leukemia m5 66. Gingival hypertrophy in a patient of acute biphenotypic leukemia. Uniquely, this patient was well enough to allow full periodontal examination and incisional gingival biopsy to be performed both before and after chemotherapy. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both.
Gingival hyperplasia is secondary to infiltration of the gingival tissue with leukemia cells and is well described in the literature. Severe alveolar bone loss and gingival hyperplasia as initial. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Drug induced gingival enlargement by rajesh hosadurga. 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. 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. Acute monocytic leukemia, acute myeloid leukemia, gingival enlargement, immunophenotyping.
Extramedullary involvement of leukemia can occur in up to 40% of patients. Case report gingival enlargement as a diagnostic indicator in leukaemia. Chronic inflammatory gingival enlargement associated with. Gingival enlargement in al is either due to leukemic infiltration, or due to reactive hyperplasia. Periodontal lesions are common in patients with acute leukemia throughout the course of the disease.
A case of gingival enlargement in acute myeloid leukemia. Gingival enlargement is one of the frequent features of gingival diseases. Gingival hyperplasia is most commonly seen with the aml subtypes acute monocytic leukemia m5 and acute myelomonocytic leukemia m4. Jun, 2012 gingival hypertrophy in a patient of acute biphenotypic leukemia. Nevertheless, the overgrowth involves the gingival margin with extension to the interdental papilla. Leukemic infiltrates in the gingivae are commonly seen in acute monocytic leukemia. Typical oral manifestations of acute leukemia include gingival swelling, oral ulceration, spontaneous gingival bleeding.
May 22, 2014 gingival enlargement in leukemia occurs due to infiltration of premature leukocytes. Gingival fine needle aspiration cytology in acute leukemia. Management of druginduced gingival enlargement australian. A case of a 19yearold male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here.
Unusual clinical presentation of generalized gingival free download as powerpoint presentation. The symptoms include gingival enlargement and bleeding, oral ulceration, petechia, mucosal pallor. Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. Gingival hyperplasia in acute leukemia stanford medicine. Here, we discuss the pathophysiology of leukemiaassociated gingival enlargement based on a case of acute myelomonocytic leukemia amlm4 with typical gingival enlargement. Prescription of calcium channel blockers is relatively common, making it difficult to determine the true incidence of druginduced gingival enlargement. Magnification of an existing inflammation initiated by dental plaque 2. One of the main drugs associated with go is the antiepileptic. Histological and immunohistochemical features of gingival. Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. 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. 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. 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 have been reported in.
Additional instructions and trouble shooting are included with the game. Abstract most of the systemic diseases manifest signs and symptoms in oral cavity. Gum hypertrophy warning sign of acute myeloblastic. Oral bleeding, gingival enlargement, ulceration and infection in patients with leukemia have been described. Primary gingival enlargement as a diagnostic indicator in acute myelomonocytic leukemia. Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611. To differentiate between them a biopsy is required, but being highly contraindicated, biopsy has been substituted in. 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. A 21 year old male presented with fever, weakness and petechiae. Gingival infiltration of leukemic cells is most commonly seen in acute monocytic leukemia m5 and acute myelomonocytic leukemia m4. Identifying gingival overgrowth as an initial oral manifestation of leukemic infiltration is extremely important for establishing an early diagnosis of acute leukemia. Gingival enlargement in leukemia occurs due to infiltration of premature leukocytes. Case report anil, s smaranayake, lakshman p nair, raj g beena, v. Intraorally it was noted both alveolar ridge and gingival enlargement.
Gingival enlargement is an increase in the size of the gingiva gums. Gingival enlargement an overview sciencedirect topics. On evaluation, he was found to have gingival hyperplasia. Gingival enlargement in myelodysplastic syndrome core. Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. One week later, there was a sudden onset of extremely generalized gingival enlargement and very high wbc count 144,000cmm was noted. Large infiltration of chronic lymphocytic leukemia in the. Gingival enlargement as a diagnostic indicator in leukaemia.
Nov 10, 2007 we report a case of a patient who presented with gingival enlargement secondary to leukaemic infiltration. Differential diagnoses of inflammatory gingival enlargement, acute leukemia, acute necrotizing ulcerative gingivitis anug and human. Mds is difficult to diagnose because of the absence of symptoms in the early stage of the disease. Oral lesions occur in both acute and chronic form of all types of leukaemias. The function of the compensating curve is the effects of plaque on vascularity of the gingival connective tissue result in 1.
Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. Unusual clinical presentation of generalized gingival. A 46 years old male, a known case of chronic myeloid leukemia reported with gum enlargement since 2 months. The main symptoms are fatigue, weight loss, fever and gingival bleeding. Gingival infiltration in acute monoblastic leukaemia.
There are several causes of gingival enlargement and they can be grouped into four categories. At this moment the patient presented hemoglobin level of 14. Among the oral manifestations, gingival hyperplasia is frequently encountered by patients with aml. Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. Images in clinical medicine from the new england journal of medicine gingival hypertrophy and leukemia. Leukemic gingival enlargement a role of periodontist in. Management of gingival hyperplasia associated with sore. The myelodysplastic syndrome mds is characterized by peripheral blood cytopenias and increased risk of transformation to acute myeloid leukemia. Gingival enlargement observed in acute leukemia is due to. The present case is a 19yearold male who was referred for further management of stage 5 chronic kidney disease. Gingival enlargement is a prominent symptom in patients with myelomonocytic leukemia amlm4 and acute monocytic leukemia amlm5. Primary gingival enlargement as a diagnostic indicator in. 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.