In hereditary gingival hyperplasia, there is a family history of gingival enlargement that usually begins with eruption of both primary and permanent teeth. In most instances, inflammatory gingival enlargement begins at an area poor oral hygiene food impaction, or other local irritation that can be readily controlled. Gingival fine needle aspiration cytology in acute leukemia. The whitecell count was 10,300 per cubic millimeter, the hematocrit was 26%, and the platelet count was 81,000. Gingival enlargement in al is either due to leukemic.
Gingival enlargement in leukemia occurs due to infiltration of premature leukocytes. Oral contraceptives induced gingival overgrowth a clinical. Hereditary gingival fibromatosis hgf is a rare genetic condition characterized by slow and progressive gingival enlargement. The patient was discharged with a wbc count of 4000 cub.
An incisional biopsy sample was obtained from the interdental gingival. Chemotherapy for chorio carcinoma was a prominent note in history. Gingival leukemic infiltration in chronic lymphocytic leukemia. Druginduced gingival hyperplasia differential diagnosis. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both. He further states6 that careful removal of local irritants is a gratifying means of reducing the gingival. Gingival enlargement associated with acute myelocytic leukemia in a child.
Gingival leukemic infiltration as the first manifestation of. There are a number of causes for this condition, but its often a symptom of poor oral hygiene or a side effect of using. May 22, 2014 genetically induced gingival enlargement appears pink in color with minimal signs of inflammation, has a slow growth rate, and is firm in consistency. Intra oral examination revealed generalized gingival enlargement. Division op hematology and oral pathology, washington university school of medicine, and hematology research laboratory, john cochran veterans administration hospital g i ingival hyperplasia with leukemic cell infiltration is a common. Leukemia, myeloblastic, gingival enlargement, signs and symptoms, acute, diffuse.
Intra oral examination revealed generalized gingival enlargement, inconsistent with the amount of calculus. Gingival leukemic infiltration as the first manifestation of acute myeloid leukemia. Gingival was bluish in colour with presence of ecchymosis in the floor of the mouth figure 2. Gingival hyperplasia is a wellestablished extramedullary presentation of leukemia. It may appear as either a diffuse enlargement of the gingival mucosa, an oversized extension of the marginal gingival. A case of diffuse gingival enlargement in acute myeloblastic. Acute monoblastic leukemia aleukemic leukemia presenting. Kalla c a department of oral medicine and radiology, jodhpur dental college, jodhpur national university, jodhpur 342001, rajasthan, india. Histopathological evaluation of a gingival biopsy specimen revealed a myeloblastoma. The observations of good oral hygiene and clinical course suggested that leukemic cell infiltration was the major cause of sudden onset of gingival enlargement. Gingival hyperplasia as an early manifestation of acute.
This is an atypical case report of a 20yearold male patient who suffered from unusual unilateral, gingival enlargement together with rapidly progressive alveolar bone loss. This article emphasizes the importance of primary gingival enlargement. Patients can experience gingival hyperplasia because of leukemic infiltration into the gums. Pdf the oral cavity manifests signs of various systemic diseases. Acute monoblastic leukemia aleukemic leukemia presenting as. Pdf on apr 17, 2020, bhupender singh negi and others published contempclindent1035652647941 072119 find, read and cite all the research you need on researchgate. The enlargement can be inflammatory,fibrotic or a combination of both. The gingival overgrowth often delays teeth eruption and may cause. In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. Case report p a 19yearold female attended the department of periodontics, hamadan university of medical sciences, hamadan, iran, with the chief complaint of generalized gingival enlargement.
Division op hematology and oral pathology, washington university school of medicine, and hematology research laboratory, john cochran veterans administration hospital g i ingival hyperplasia with leukemic. Gingival hyperplasia in acute leukemia stanford medicine. Gingival hyperplasia as an early diagnostic oral manifestation in acute monocytic leukemia. Typical oral manifestations of acute leukemia include gingival swelling, oral ulceration, spontaneous gingival bleeding, petechiae, mucosal pallor, herpetic. Periodontal findings of a 19yearold female with previously undiagnosed acute myeloid leukemia aml are presented.
The acute leukemias are a group of neoplastic diseases that are characterized by proliferation of immature white cells in the bone marrow andor blood and are often associated with severe leucopenia, anemia and. Patients can experience gingival hyperplasia because of leukemic. Prescription of calcium channel blockers is relatively common, making it difficult to determine the true incidence of druginduced gingival enlargement. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Soft, edematous, tender gingiva with ease to bleeding is a sign in blood disorders.
Gingival leukemic infiltration in chronic lymphocytic leukemia cary a. Shamimul hasan, nabeel ishrat khan, 1 and l bhaskar reddy 2. His oral hygiene was poor with presence of local factors. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Acute myeloid leukemia, chemotherapy, gingival overgrowth. Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Gingival enlargement associated with vitamin c deficiency neoplasms developmental gingival enlargement. Gingival enlargement as oral manifestation in acute myeloid. Gingival enlargement leading to the diagnosis of acute lymphoblastic leukemia in an 8year old girl. 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. Oral signs of leukemia and dental management literature. Gingival enlargement as oral manifestation in acute myeloid leukemia patient. Oral findings in acute leukemia al are common and could be the presenting feature of the disease, namely, gingival enlargement, ulceration, bleeding, and infection.
Pdf gingival enlargement leading to the diagnosis of acute. It manifests as diffuse or solitary and localized or generalized. The enlarged gingiva completely covered his left posterior teeth in both arches. Case report this case report describes a 9yearold female who presented with gingival enlargement after wearing an orthodontic appliance.
The patient was diagnosed with acute myelocytic leukemia. Gingival hyperplasia is secondary to infiltration of the gingival tissue with leukemia cells and is well described in the literature. A case of gingival enlargement in acute myeloid leukemia. Leukemic gingival enlargement a role of periodontist in. Pdf gingival enlargement leading to the diagnosis of. The differential diagnosis of gingival hyperplasia includes poor oral hygiene, medications like cyclosporine and phenytoin, systemic illnesses like sarcoidosis or crohns disease, hematological disorders like aml, and genetic conditions. However, the pseudo pockets formed by gingival enlargement make the maintenance of good oral hygiene difficult, perpetuating a cycle of inflammation and fibrosis the involved. This case stresses the importance of taking a thorough. Based on the clinical picture, the case history and patients response to the treatment, a provisional diagnosis of gingival enlargement due to oral contraceptive was made. Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. Gingival hyperplasia complicating acute myelomonocytic leukemia. Gingival enlargement in acute myeloblastic leukemia. According to glickman,5 true leukemic gingival enlargement occurs pri marily in the acute form of the disease, in the presence of gingival irritation. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients.
Leukemic gingival enlargement was ruled out as the complete blood hemogram failed to indicate any abnormalities. Management of druginduced gingival enlargement australian. There are several causes of gingival enlargement and they can be grouped into four categories. Case report histological and immunohistochemical features. Bds third professional examination 2007 periodontology mcqs model paper 25. Gingival enlargement in al is either due to leukemic infiltration, or due to reactive hyperplasia. An otherwise healthy 36yearold man presented with a 6day history of bleeding gums and abdominal pain in the left upper. Gingival hyperplasia is most commonly seen with the aml subtypes acute monocytic leukemia m5 66. Systemic diseases that cause gingival enlargement several systemic diseases may result in gingival enlargement through different mechanisms these are usually. Gingival overgrowth or gingival enlargement is an increase in size of the gingiva and accounts to one of the many types of periodontal diseases. On palpation, gingiva was soft and oedematous without stippling and was tender on palpation. Gingival enlargement associated with acute myelocytic.
Gingival hyperplasia can be a recurrent condition despite improvements in oral hygiene, professional treatment, and drug substitutions. This article emphasizes the importance of primary gingival enlargement in the initial diagnosis of leukemia. Ruling out other etiologies, second cbc and peripheral blood smear results confirmed aml. A remarkable example of gingival hyperplasia was observed in a 35yearold dentate man referred to our oncology department with a onemonth history of fatigue, anorexia and gingival enlargement initially identified by his dentist. Systemic conditions such as hormonal changes, drug therapy, or tumor infiltrates may also cause or contribute to the severity of gingival enlargement. Aleukemic or subleukemic forms of amls are more likely to present as gingival enlargements in adults.
Fetor oris and gingival hemorrhage, two often coexisting findings with gingival hyperplasia related to leukemia. Gingival enlargement in acute myeloid leukemia 49 ness in supraclavicular lymph nodes as well as a pale appearance. Gingival hyperplasia is an overgrowth of gum tissue around the teeth. In this paper, we report a case of gingival enlargement due to acute myeloid leukemia. Acute myeloblastic leukemia aml is a malignant disease of bone marrow, usually presenting gingival overgrowth as its first clinical manifestation. Identifying gingival overgrowth as an initial oral manifestation of leukemic. Primary gingival enlargement as a diagnostic indicator in. In recent years,flap surgery have been used more often to treat gingival enlargement. Aug 12, 2014 treatment of gingival enlargement in puberty gingival enlargement in puberty is treated by performing scaling and curettage, removing all sources the use of escharotic drugs has been recommended in the past for the removal of gingival enlargements of irritation, and controlling plaque. Gingival enlargements free download as powerpoint presentation. Gingival enlargement is one of the frequent features of gingival diseases. Based on the clinical picture, the case history and patients response to the treatment, a provisional diagnosis of gingival enlargement. 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 during pregnancy and converted to choriocarcinoma.
Oral manifestations in acute leukemia as the first sign. Gingival involvement is common in aml and found in 66. An otherwise healthy 36yearold man presented with a 6day history of bleeding gums and abdominal pain in the left. Gingival enlargement and its treatment authorstream. Gingival enlargement as an early diagnostic indicator in therapy. Leukemic gingival enlargement leukemic enlargement occurs in acute or subacute. Leukemic gingival enlargement a role of periodontist in early diagnosis and prompt referral.
Case report this case report describes a 9yearold female who presented with gingival enlargement after. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. He further postulated that the gingival hypertrophy resulted from large cxtravascular leukemic infiltration and changes secondary to infarcted areas. Furthermore, a biopsy was indicated to exclude other gingival diseases that can cause gingival enlargement. Oral signs of leukemia and dental management literature data and case report elitsa g. Gingival infiltration by leukemic cells will also predispose the patient with leukemia to bleeding 1. This entails thorough examination of the oral mucosa, gingiva, teeth, tongue. This is strictly a clinical description of the condition and avoids the erroneous pathologic connotations of terms used in the past such as hypertrophic gingivitis or gingival hyperplasia.
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