Regular oral screening and vigilance: can it be a potential lifesaver?

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Regular oral screening and vigilance: can it be a potential lifesaver?

Madhu Singh Ratre, Ruchi Gulati, Shaleen Khetarpal, Ajay Parihar1


Acute myeloid leukemia (AML) is a malignant neoplasm of myeloid series defined by the presence of immature blast cells (>30%) in peripheral circulation. Oral manifestations are the potential indicators of systemic health and disease. Oral cavity is the frequently and early involved sites in AML. Gingival overgrowth due to leukemia is one such condition encountered by periodontists. Hence, understanding, identifying, and correlating oral manifestations with systemic diseases are the ultimate responsibility of every dental clinician because of its lethal and unpredictable course. In the present case, we are discussing an undiagnosed case of AML who presented to us with oral complaints.

Key words:

Diagnosis, gingival enlargement, leukemia, myeloid, oral manifestation, systemic disease.


The health of oral cavity is a remarkable reflection of systemic status.[1] Identification of the signs and symptoms of oral lesions can act

as a warning sign of hidden and serious systemic involvement.[1] Gingival overgrowth (GO) is one of the frequently encountered diseases/conditions by the oral health practitioners, especially periodontists.[2] GO can be categorized into inflammatory, drug‑induced GO (DIGO), gingival enlargement associated with systemic diseases and conditions, neoplastic, and false enlargement.[3]

Leukemia is a heterogeneous group of hematologic disorders that arise from hematopoietic stem cells, characterized by disordered differentiation and proliferation of neoplastic cells. On the basis of clinical behavior and histogenetic origin, leukemia is classified as acute myeloid leukemia (AML), acute lymphoid leukemia, chronic myeloid leukemia, and chronic lymphoid leukemia. AML is neoplasia of the myeloid series of blood cells, manifested by the rapid growth of abnormal cells with destruction and replacement of bone marrow and presence of anaplastic cells in peripheral circulation. AML progresses rapidly and is typically fatal within weeks or months if left untreated.[4]

The relationship between leukemia and a wide variety of oral lesions has been well documented in many studies.[5,6] Several undiagnosed cases of leukemia may report to the dentist with chief complaints related to oral lesions.

Oral manifestations of leukemia include petechial hemorrhages (56%), oral ulcerations (53%), gingival enlargement (36%), and spontaneous gingival bleeding.[7,8] General systemic features include fatigue, anemia, lymphadenopathy, recurrent infections, bone and abdominal pain, enlargement of liver and spleen, bleeding, and purpura.[9] Hereby, we attempt to discuss an undetected case of AML who reported to dental hospital with oral complaints.

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