Evaluation of Oral Manifestations in Hematologic Malignancies

Introduction: In this survey, we tried to evaluate the prevalence of oral manifestations and the effect of chemotherapy on the patients with hematologic malignancy admitted in Shiraz Nemazze Hospital during 2004. Methods: We included all 18 adult and pediatric patients due to hematologic malignancy during one month into the oncology ward of Nemazee Hospital admitted. Demographic data, clinical findings including oral and extraoral manifestations, laboratory findings and information on chemotherapy were obtained. Eighteen other patients with non-hematologic cancers undergoing chemotherapy in this ward were selected as controls. The severity of oral manifestations was classified as mild (0-1 findings), moderate (2-4) and severe (5 or more). Results: The average number of oral manifestations was 3.4±0.9 in the case group and 1.4±0.4 in controls (p<0.05). Severe findings were found in 42.8% of A.L.L. patients, 60.0% of A.M.L. patients, 75% of lymphoma patients and 50.0% of hairy cell leukemia patients. The first presentation of the disease was gingival bleeding in 11.1% and head or neck mass in 5.6% of patients. No significant differences in oral findings were seen between adults and children or those with normal and abnormal blood counts. Also, no significant relationship was found between the number of oral findings and months after diagnosis. The most common findings were mucosal pallor in 94.4% of cases (vs. 16.7% of controls), petechia in 55.6% (vs. 11.1%), mucosal ulcer in 33.3% (vs. 16.7%) and herpes infection in 33.3% (vs. 11.1%). Conclusion: Oral findings occured more commonly in patients with hematologic malignancies, were more common after chemotherapy, and occurred more than patients on chemotherapy but with non-hematologic malignancies. Good oral hygiene and careful differential diagnosis and work up of patients will aid in earlier diagnosis and therefore better prognosis of patients with hematological malignancies.