Oral manifestation of leukemia

1. Oral Pathology 1
Leukemia
Professor: Dr. Jay Hansel Tabije
subj/sec: DOP 221 / DDA
Name: Khafi Makoo , Noorallah

2. Leukemia
A group of malignant disorders affecting the
blood and blood-forming tissues of
 Bone marrow
 Lymph system
 Spleen
Occurs in all age groups

3. Leukemia
 Results in an accumulation of dysfunctional cells
because of a loss of regulation in cell division
 Fatal if untreated
– Progressive
 Often thought of as a childhood disease
 The number of adults affected with leukemia is 10 times
that of children

4. Leukemia
Etiology and Pathophysiology
 No single causative agent
 Most from a combination of factors
 Genetic and environmental influences
 Associated with the development of leukemia
Chemical agents
Chemotherapeutic agents
Viruses
Radiation
Immunologic deficiencies

5. Leukemia
Classification
• Acute versus chronic
– Cell maturity
Acute: clonal proliferation of immature
hematopoietic cells (the formation of blood or blood
cells )
Chronic: mature forms of WBC; onset is more
gradual
– Nature of disease onset

6. Leukemia
Classification
Type of white blood cell (WBC)
Acute lymphocytic leukemia (ALL)
Acute myelogenous leukemia (AML)
 Also called acute nonlymphoblastic leukemia (ANLL)
Chronic myelogenous leukemia (CML)
Chronic lymphocytic leukemia (CLL)

8. Clinical Features of Acute
Leukemia
-Symptoms
Anaemia: pallor, tiredness,
breathlessness
Neutropenia: mouth ulcers, infections
Leucocytosis: general malaise,
breathlessness, confusion, pain, extra
medullary tumours
Thrombocytopenia: bruising, bleeding

9. Clinical Findings/signs
Pallor
Bruising, bleeding
Mouth ulcers
Lymphadenopathy: ALL>AML
Hepato/splenomegaly: ALL>AML
Testicular involvement: ALL

10. Oral manifestation of ALL
The most common oral manifestations are seen with
this type of leukemia , which include
1) exudation from gingivae
2) hematomas
3) lymphadenopathy
4) oral ulceration and
5) pharyngitis.
6) Spontaneous hemorrhage

13. Acute lymphocytic leukemia with
gingival ulceration in a child.

14. Cerebral bleed pallor and purpura hyphaema lymphadenopathy
Retinal bleeds gum infiltration skin infiltration

17. Acute myelogenous leukemia with
extensive swelling of the gingiva.

18. Acute myelogenous leukemia with petecchia
and swelling of the gingiva. This patient had several
episodes of spontaneous bleeding from the
gingiva, which prevented oral hygiene procedures
from being undertaken.

19. Acute myelocytic leukemia.
A: View of patient's face. Note the elevated flat macules and papules on the right
cheek.
B: Intraoral view showing the pronounced gingival enlargement.
C: Occlusal view of upper anterior teeth. Note the marked enlargement in both the
facial and the palatal aspects.

20. Chronic Leukemias
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
of40

21. 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.

22. 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.

27. Thank YOU