Leukaemiain periodontology This work is done by Dr.ahmed salih Dr.evan mohammed
Leukaemia :-Leukemia (American English) or leukaemia (BritishEnglish; Greek leukos , "white"; aima , "blood") is acancer of the blood or bone marrow characterizedby an abnormal increase of blood cells, usuallyleukocytes (white blood cells). Leukemia is a broadterm covering a spectrum of diseases. In turn, it ispart of the even broader group of diseases calledhematological neoplasms.Its considered as a risk factor in periodontitis.
*Classification of Leukaemia-Acute-Chronic-Myeloid-Lymphoid
* Gingival manifestation of leukemia :-which include extensive swelling, ulceration , petecchia (Fig.12-51), and erythema, are much more common in acute than inchronic forms. Sometimes the manifestations lead to thediagnosis of leukemia.Thus, 69% of patients with acute leukemia hadoral signs of leukemia on examination and 33% of thepatients had gingival swelling (Pindborg 1992). Inanother study gingival swelling was revealed in 21%of AML patients but in no patients with ALL (Meyeret al. 2000). The latter group, on the other hand,showed both gingival erythema and ulcer in 36%. Inleukemic children, only 10-17% appear to possess gingivalswelling (Curtis 1971, Michaud et al. 1977).
*Acute Leukaemia-Acute leukemias have an aggressive courseresulting in death within 6 months if untreated. Theyoccur rather seldom and patients are usually eitherunder 20 or over 60 years of age-Rapidly progressive-Proliferation of primitive “blast” cells-Acute myeloblastic (myeloid) leukaemia “Acute non-lymphoblastic leukaemia”-Acute lymphoblastic leukaemia
*Clinical Features of Acute Leukaemia-SymptomsAnaemia: pallor, tiredness, breathlessnessNeutropenia: mouth ulcers, infectionsLeucocytosis: general malaise,breathlessness, confusion, pain, extramedullary tumoursThrombocytopenia: bruising, bleeding
*Clinical Findings/signs*Pallor*Bruising, bleeding*Mouth ulcers*Lymphadenopathy: ALL>AML*Hepato/splenomegaly: ALL>AML*Testicular involvement: ALL
*Oral manifestation of ALL :-The most common oral manifestations are seen withthis type of leukemia , which include1) exudation from gingivae,2) hematomas,3) lymphadenopathy,4) oral ulceration and5) pharyngitis.6) Spontaneous hemorrhage
Acute lymphocytic leukemia with gingival ulceration in a child.
** Peak incidence in children aged 4 years* Rising incidence in old age13 17/03/2012
* 1.2% of cancer deaths Median age at diagnosis 63 years Male > female North america, europe, oceania > asia, latin america14 17/03/2012
These two patients had acutemyelogenous leukemia. Note the severe gingivo- periodontal involvementas well as the liphemorrhage.
Acute myelogenous leukemia with extensive swelling of the gingiva.
Acute myelogenous leukemia with petecchiaand swelling of the gingiva. This patient had severalepisodes of spontaneous bleeding from thegingiva, which prevented oral hygiene proceduresfrom being undertaken.
Acute myelocytic leukemia. A, View of patients face. Note the elevatedflat macules and papules on the right cheek. B, Intraoral view showingthe pronounced gingival enlargement.C, Occlusal view of upper anterior teeth. Note the marked enlargementin both the facial and the palatal aspects.
** Myeloid * Myelo-proliferative disorders * Chronic * Myeloid, neutrophilic, eosinophilic, basophilic* Lymphoid * Chronic lymphocytic leukaemia * is the most common, * have less pronounced bone marrow failure and a more indolent course usually lasting several years. They occur during adulthood and normally after the age of4021 17/03/2012
Epidemiology CML accounts for approximately 15 percent of all cases of leukemia and approximately 3 percent of childhood leukemias The median age of onset is 53 years22 17/03/2012
*Gingivitis Due to Leukemia* In fact, gingivitis is the first sign of disease in about 25% of children with leukemia. An infiltration of leukemic cells into the gingivae considered as a main factor in leukemic induced gingivitis The giniva appear red and bleed easily. Often, the bleeding continues for several minutes or more because blood does not clot normally in people with leukemia.* A person with gingivitis due to leukemia can prevent bleeding by gently wiping the teeth and gingiva with a gauze pad or sponge instead of brushing and flossing. Dentists can prescribe chlorhexidine.* mouth rinse to control plaque and prevent mouth infections. When the leukemia is in remission (when evidence of the cancer disappears), good dental care can restore the gums to health.
*Dental care :-*No treatment should be carried out until the patient is in remission unless the emergency treatments.*Oral hygiene improvement , swabbing with antibacterial agent*Inferior dental block is contraindicated*Bleeding time and platelet count should be checked before extensive scaling to prevent more bleeding*Prescribe oral drugs depending on type of infection presents.