Leukemia early detection at dental clinic due to gingival bleeding

Objectives: Many systemic diseases have oral manifestations which may appear at the beginning of any developed pathology, thus early detection can occasionally occur at the dental clinic. Gingival lesions are the most common oral phenomenon known for Leukemia. In this case an early detection of Leukemia at the dental clinic was based on an uncommon and single presenting sign of massive spontaneous gingival bleeding. The objectives are: 1. Demonstrate this unusual sign of Leukemia in oral cavity. 2. Maintain awareness to existence of oral manifestations of systemic diseases.

Methods: A 25 year old officer appears at the dental clinic in an Air Force base camp complaining about a spontaneous bleeding from the gingiva. After a clinical and radiographic examination, an Ultrasonic scaling was performed. In addition, the dentist referred him to his physician for comprehensive examination including blood tests. Two hours later the patient returned to the clinic with a massive gingival bleeding from the upper left quadrant. The soldier was immediately referred to the emergency room and was diagnosed with Acute ProMyelocytic Leukemia. (A.P.L)

Results: Leukemia has several known oral signs. Most common are gingival hypertrophy and hyperplasia. In this case gingival bleeding was the only atypical presenting sign leads to an early diagnosis of Leukemia.

Conclusion: Oral symptoms for systemic diseases are common and variegated. The dental surgeon is often the first medical authority a patient see. Hence, the dentist should be aware of any unusual or unknown signs and conscious of their possible entire manifestation.