Oral Manifestations and Complications in Childhood Acute Myeloid Leukemia

Abstract

Acute myeloid leukemia (AML) is a heterogeneous group of diseases, whose classification is based on lineage-commitment and genetics. Although rare in childhood, it is the most common type of acute leukemia in adults, accounting for 80% of all cases in this age group. The prognosis of this disease remains poor (especially in childhood, as compared to acute lymphoblastic leukemia); however, overall survival has significantly improved over the past 30 years. The health of the oral cavity is a remarkable reflection of the systemic status of an individual. Identification of the signs and symptoms of oral lesions can act as a warning sign of hidden and serious systemic involvement. Moreover, they may be the presenting feature of acute leukemia and provide important diagnostic indicators. Primary oral alterations are identified in up to 90% of cases of acute myeloid leukemia and consist of petechiae, spontaneous bleeding, mucosal ulceration, gingival enlargement with or without necrosis, infections, hemorrhagic bullae on the tongue, and cracked lips. Poor oral hygiene is a well-known risk factor for local and systemic infectious complications. Oro-dental complications due to AML treatment can affect the teeth, oral mucosa, soft and bone tissue, and contribute to opportunistic infections, dental decay, and enamel discoloration. The treatment of acute myeloid leukemia is still associated with high mortality and morbidity. The management is multimodal, involving aggressive multidrug chemotherapy and, in most cases, allogenic bone marrow transplantation. Periodontal and dental treatment for patients with leukemia should always be planned and concerted with hematologists.

Keywords: acute myeloid leukemia; leukemia; oral manifestations; treatment.

Figure 1

(A) Caries in the lower primary molars, intraoral bleeding, and gingival enlargement/hyperplasia. (B) Cracked lips and gingival enlargement. (C) Cracked lips, gingival enlargement/hyperplasia, and buccal bleeding.

Figure 2

(A) Enamel discoloration and presence of calculus stone. (B) Picture showing intraoral view of patient shown in Figure 2A after removal of the discoloration and calculus stone in a few sessions of scaling and polishing.