ORAL' MANIFESTATIONS IN SYSTEMIC DISEASES ...

H. H. STONES
The leukaemias can be classified depending on whether the condition
is acute or chronic and on the type of cell involved; also there is the
aleukaemia phase to be considered. They all have a fatal termination.
(a) Acute leukaemia (myelogenous, lymphatic and monocytic types).
In acute leukaemia the total white count may not be high at the beginning
but is raised to an extent that may vary from 20,000 to upwards of
100,000 per cmm. in the terminal stages.
In the myelogenous type the predominant cells are the primitive
myeloblasts and myelocytes, these forming 80-90 per cent. of the count.
In the lymphatic type, lymphoblasts and lymphocytes similarly form
some 90 per cent. of the count.
In the monocytic type, the monocytes predominate.
There is usually a thrombocytopenia.
The disease most frequently occurs in childhood. The oral mucosa is
affected at an early stage. Frequently the gingivae are swollen and
tend to bleed. They become dark red in colour as the condition
progresses and there may be a tendency to slow but continuous
haemorrhage. Ulcerative lesions develop in the gingivae, palate and
fauces which become secondarily infected and rapidly progress to
gangrene.
Biopsy of the gums shows infiltration with the primitive cells. Burket
(1944) states that the extensive sloughing and occasionally observed
periapical abscess are due to thrombosis of the vessels supplying these
parts.
There are severe haemorrhages from other mucous membranes and
pyrexia and bleeding into the skin. As a result of the continuous
haemorrhages, signs of secondary anaemia develop with a low haemoglobin
and colour index. Eventually there are petechiae and ecchymoses
on the skin.
Neither the spleen nor lymph nodes are markedly enlarged in the acute
conditions. The termination is fatal in either several weeks or months.
Fitzgerald (1943) has reported nine cases and Matheson (1949) four
cases of leukaemia.
Two patients have come under observation who demonstrate the
importance of these diseases to the dental practitioner. The first is of
interest as the gingival condition has been the first symptom of acute
leukaemia. The patient, a female aged 16 years, attended because of
bleeding from the gums on the slightest provocation. There was a
history of haemorrhage following a previous tooth extraction. Examination
revealed swelling of the gingivae. The patient was pale, but stated
she felt well.
Blood examination showed an acute leukaemia with an almost daily
change from a monocytic to myelogenous type. The termination was
fatal in four weeks' time.
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