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ACUTE MYELOGENOUS LEUKEMIA(AML) Tesoro, Willianne C. DMD-2D
ACUTE MYELOGENOUS LEUKEMIA (AML) is a clonal hematopoietic disorder resulting from genetic alterations in normal hematopoietic stem cells. These changes alter normal hematopoietic growth and differentiation, resulting in an accumulation of large numbers of abnormal, immature myeloid cells in the bone marrow and peripheral blood. These cells are capable of dividing and proliferating, but cannot differentiate into mature hematopoietic cells. AML is more common in men than women. AML is the most common acute leukemia affecting adults, and its incidence increases with age.
SIGNS AND SYMPTOMS Fever Fatigue Loss of appetite Weight loss Frequent infections Shortness of breath Weakness Swelling of lymph nodes Spleen/Liver enlargement Pallor Easy bleeding and bruising Petechiae (red spots) on the mucosa Gingival swelling Ulcers are often found on the mucosa or gingival Oral Candidiasis/Oral thrush
DENTAL CORRELATION OF THE DISEASE IN DENTALTREATMENT Hematological information is needed before any invasive procedures (such as extractions )as leukemia patients have higher bleeding tendencies and they are liable to infections. Preventive oral care is important in leukemia patients. Early intervention is important to reduce the possible complications. Frequent topical fluoride applications Fissure sealants on the molars to reduce dental caries. Dietary advice to the patient Give proper tooth brushing instructions to both patient and parents. Antibiotic cover is needed before any surgery to prevent any postoperative infection. Local anesthesia should be avoided to prevent any hemorrhagic tendency. Root canal treatment is preferred over extractions to reduce the risk for oral and systemic complications Dental treatment should be performed as a traumatically as possible to prevent any injuries to the soft tissues. Fixed and removable orthodontic appliances are not recommended for patients with poor oral hygiene. Preshedding deciduous teeth should be left to exfoliate naturally and patient should not play with it with his/her tongue to reduce bacteremia. Local measures such as placing sutures, gelatin sponge are required to stop/arrest bleeding when a minor/major surgery is performed.
Leukemia patients should maintain their oral hygiene by: Brush twice daily using a soft toothbrush to reduce the risk of significant bleeding and infection of the gingival. Attending the dental appointments regularly to monitor their oral condition. Remove plaque effectively to prevent formation of dental caries Rinse after meal to avoid accumulation of plaque/food debris
CLASSIFICATION OF AML Multifactorial -The barriers to curing AML are multifactorial, including drug resistance, poor tolerance of induction therapy, and very high rates of relapse. Single Gene - The affected people may have a single gene or multiple genes in common. In some cases, families tend to develop the same kinds of leukemia as other members; in other families, affected people may develop different forms of leukemia or related blood cancers. Cytogenetics - The translocation t(8;21)(q22;q22) is one of the most common structural aberration in acute myeloid leukemia and is found in 5-12% of AML