my seminar in periodontology

1. Leukaemia
in periodontology
This work is done by
Dr.ahmed salih
Dr.evan mohammed

2. 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.

3. *Classification of Leukaemia
-Acute
-Chronic
-Myeloid
-Lymphoid

4. * 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).

5. *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

6. *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

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

8. *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

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

12. Cerebral bleed pallor and purpura hyphaema lymphadenopathy
12
Retinal bleeds gum infiltration skin infiltration
17/03/2012

13. *
* Peak incidence in children
aged 4 years
* Rising incidence in old age
13 17/03/2012

14. *
1.2% of cancer
deaths
Median age at
diagnosis 63 years
Male > female
North america,
europe, oceania >
asia, latin america
14 17/03/2012

15. These two
patients had
acute
myelogenous
leukemia.
Note the
severe
gingivo-
periodontal
involvement
as well as the
lip
hemorrhage.

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

19. 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.

20. 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.

21. *
* 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 17/03/2012

22. 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
22 17/03/2012

23. *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.

24. *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.

30. *
YOU !!