Leukaemia in periodontology

This work is done by Dr.ahmed salih

Dr.evan mohammed

Leukaemia :-Leukemia (American English) or leukaemia (British English; Greek leukos , "white"; aima , "blood") is a cancer of the blood or bone marrow characterized by an abnormal increase of blood cells, usually leukocytes (white blood cells). Leukemia is a broad term covering a spectrum of diseases. In turn, it is part of the even broader group of diseases called hematological 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 in chronic forms. Sometimes the manifestations lead to the diagnosis of leukemia.

Thus, 69% of patients with acute leukemia had

oral signs of leukemia on examination and 33% of the

patients had gingival swelling (Pindborg 1992). In

another study gingival swelling was revealed in 21%

of AML patients but in no patients with ALL (Meyer

et al. 2000). The latter group, on the other hand,

showed both gingival erythema and ulcer in 36%. In

leukemic children, only 10-17% appear to possess gingival

swelling (Curtis 1971, Michaud et al. 1977).

*Acute Leukaemia

-Acute leukemias have an aggressive course

resulting in death within 6 months if untreated. They

occur rather seldom and patients are usually either

under 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

-Symptoms

Anaemia: pallor, tiredness, breathlessness

Neutropenia: mouth ulcers, infections

Leucocytosis: general malaise, breathlessness, confusion, pain, extra medullary tumours

Thrombocytopenia: 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 with this type of leukemia , which include

1) exudation from gingivae,

2) hematomas,

3) lymphadenopathy,

4) oral ulceration and

5) pharyngitis.

6) Spontaneous hemorrhage

Acute lymphocytic leukemia with gingival ulceration in a child.

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Cerebral bleed pallor and purpura hyphaema lymphadenopathy

Retinal bleeds gum infiltration skin infiltration

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*Epidemiology of ALL

*Peak incidence in children aged 4 years

*Rising incidence in old age

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*Epidemiology of AML

1.2% of cancer deaths

Median age at diagnosis 63 years

Male > female

North america, europe, oceania > asia, latin america

These two patients had

acute myelogenous

leukemia. Note the severe

gingivo-periodontal involvement

as well as the lip

hemorrhage.

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 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.

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*Chronic Leukaemias

*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. Theyoccur during adulthood and normally after the age of40

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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 years

*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.

*THANK

YOU !!