ORAL' MANIFESTATIONS IN SYSTEMIC DISEASES ...

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ORAL MANIFESTATIONS IN SYSTEMIC DISEASES The second patient was a male aged 16 years who developed acute myelogenous leukaemia following tooth extraction, though there had previously been no sign of the disease. There was marked enlargement and ulceration of the gingivae with gangrene of the soft palate and fauces, which sloughed away. There was a continuous and intractable oozing of blood from the oral tissues. The blood picture was typical of myelogenous leukaemia. The patient only survived for several weeks. (b) Chronic leukaemia (myelogenous and lymphatic types).-In chronic myelogenous leukaemia the white cell count shows an increase up to 200,000 or even to 500,000 per cmm. In the early stages adult polymorphonuclears predominate though myeloblasts and myelocytes are present. In chronic lymphatic leukaemia the white cell count may reach 50,000 to 100,000 per cmm. of which some 90 per cent. are small lymphocytes with occasional lymphoblasts. In both types the primitive cells gradually increase until the blood, after a varying period of time, presents the features of the acute type. Chronic leukaemias frequently occur in middle age. In both types the onset is gradual. Hypertrophic gingivitis occurs but the gingival lesions are not so striking unless an acute stage develops and then there is the tendency to the gingival features already described. In chronic myelogenous leukaemia the characteristic feature is a considerably enlarged spleen. In the lymphatic type there is enlargement of the lymph nodes and the spleen is also sometimes increased in size. (c) Aleukaemic leukaemia.-In this condition the total number of white cells is low and sometimes may only reach 1,000 per cmm., but immature cells are present which may be either of the myoblast, lymphoblast or monoblast type. These cases develop into one of the typical leukaemias described above. A case with unilateral swelling and pain of the jaw and hypertrophic gingivitis of the same side has been reported by Neger (1939). Infectious Mononucleosis In glandular fever there is a leucocytosis of 10,000 to 30,000 cells per cmm. Lymphocytes, many of which show the morphology of " monocytoid" cells, eventually form from 60 to 90 per cent. of the total, though this may not be the case in the early stages. It is characterized by respiratory symptoms and temperature. There may be oedema and inflammation of the pharynx, soft palate and uvula, and ulceration of the fauces. Ravenna and Snyder (1948) have reported the oral mucosa as being sometimes inflamed though to a lesser extent, together with the other features in a group of young adults. There is enlargement of the lymph nodes, especially the cervical group. 243
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