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Leukemic gingival enlargement: Report of a rare case with review of literature.

Hasan S, Khan NI, Reddy LB - Int J Appl Basic Med Res (2015 Jan-Apr)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, Okhla, New Delhi, India.

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.

No MeSH data available.


Related in: MedlinePlus

(a) Generalized gingival enlargement involving maxillary and mandibular arch. (b) Boggy, reddish-blue gingiva on the buccal, labial, palatal and lingual aspect of marginal and attached maxillary gingiva. (c) Enlarged gingiva covering the crown surface with a mild ecchymosis in the floor of the mouth
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Figure 1: (a) Generalized gingival enlargement involving maxillary and mandibular arch. (b) Boggy, reddish-blue gingiva on the buccal, labial, palatal and lingual aspect of marginal and attached maxillary gingiva. (c) Enlarged gingiva covering the crown surface with a mild ecchymosis in the floor of the mouth

Mentions: An 18-year-old female patient from low socioeconomic status reported to the outpatient Department of Oral Medicine and Radiology, with a complaint of swollen and bleeding gums for the past 1-month. Gingival swelling progressed slowly within the last 20 days and was associated with bleeding and tenderness. Medical history revealed that the patient experienced lethargy, slight weight loss and loss of appetite in the last few months. However, she denied the intake of any medications for chronic illness. Physical examination revealed that the patient was poorly built and nourished with petechial spots on the skin in the forearm and legs. Bilateral submandibular and deep cervical lymphadenopathy was appreciated. Lymph nodes were indurated and tender on palpation. Intraoral examination revealed generalized gingival enlargement on the buccal, labial, palatal and lingual aspect of marginal and attached gingiva of the maxillary and mandibular arches [Figure 1a-c]. Gingiva was swollen, glazed, shiny, bluish red in color with areas of a mild ecchymosis in the floor of the mouth. Gingival enlargement extended on to one-third to one-half of the crown portion of teeth. The patient had a foul odor and fair oral hygiene. On palpation, gingiva was soft, edematous, devoid of stippling and tender on palpation. Gingival bleeding on slight provocation was also appreciated. Orthopantomogram did not revealed bony involvement. Inflammatory gingival enlargement, drug induced enlargement, conditioned gingival enlargement, and systemic gingival enlargement were considered in the differential diagnosis. Inflammatory enlargement was ruled out as the inflammatory component (plaque and calculus) was not significant to the severity of the presented gingival enlargement. Drug-induced enlargement was ruled out as thorough history taking did not reveal the intake of any drug significant for gingival enlargement. However, features of lethargy, weight loss and loss of appetite along with the rapidly progressive gingival overgrowth and presence of ecchymosis in the floor of the mouth substantiated an underlying systemic disease.


Leukemic gingival enlargement: Report of a rare case with review of literature.

Hasan S, Khan NI, Reddy LB - Int J Appl Basic Med Res (2015 Jan-Apr)

(a) Generalized gingival enlargement involving maxillary and mandibular arch. (b) Boggy, reddish-blue gingiva on the buccal, labial, palatal and lingual aspect of marginal and attached maxillary gingiva. (c) Enlarged gingiva covering the crown surface with a mild ecchymosis in the floor of the mouth
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318106&req=5

Figure 1: (a) Generalized gingival enlargement involving maxillary and mandibular arch. (b) Boggy, reddish-blue gingiva on the buccal, labial, palatal and lingual aspect of marginal and attached maxillary gingiva. (c) Enlarged gingiva covering the crown surface with a mild ecchymosis in the floor of the mouth
Mentions: An 18-year-old female patient from low socioeconomic status reported to the outpatient Department of Oral Medicine and Radiology, with a complaint of swollen and bleeding gums for the past 1-month. Gingival swelling progressed slowly within the last 20 days and was associated with bleeding and tenderness. Medical history revealed that the patient experienced lethargy, slight weight loss and loss of appetite in the last few months. However, she denied the intake of any medications for chronic illness. Physical examination revealed that the patient was poorly built and nourished with petechial spots on the skin in the forearm and legs. Bilateral submandibular and deep cervical lymphadenopathy was appreciated. Lymph nodes were indurated and tender on palpation. Intraoral examination revealed generalized gingival enlargement on the buccal, labial, palatal and lingual aspect of marginal and attached gingiva of the maxillary and mandibular arches [Figure 1a-c]. Gingiva was swollen, glazed, shiny, bluish red in color with areas of a mild ecchymosis in the floor of the mouth. Gingival enlargement extended on to one-third to one-half of the crown portion of teeth. The patient had a foul odor and fair oral hygiene. On palpation, gingiva was soft, edematous, devoid of stippling and tender on palpation. Gingival bleeding on slight provocation was also appreciated. Orthopantomogram did not revealed bony involvement. Inflammatory gingival enlargement, drug induced enlargement, conditioned gingival enlargement, and systemic gingival enlargement were considered in the differential diagnosis. Inflammatory enlargement was ruled out as the inflammatory component (plaque and calculus) was not significant to the severity of the presented gingival enlargement. Drug-induced enlargement was ruled out as thorough history taking did not reveal the intake of any drug significant for gingival enlargement. However, features of lethargy, weight loss and loss of appetite along with the rapidly progressive gingival overgrowth and presence of ecchymosis in the floor of the mouth substantiated an underlying systemic disease.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, Okhla, New Delhi, India.

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.

No MeSH data available.


Related in: MedlinePlus