002 Medicine

General Medicine#3&4 WBCs Disorders
Disorders of white blood cells (WBCs) in the dental patient can

greatly influence clinical decision making as well as the specifics of
care, because WBCs provide the primary defense against microbial
infections and are critical for mounting an immune response. Three
groups of WBCs are found in the peripheral circulation: granulocytes,
lymphocytes, and monocytes.
Leucopenia is a white blood cell count of less than 4.0 × 109/L. It

may be the result of a disease process such as HIV infection or the
early stages of leukaemia. Alternatively it may be caused by drug
therapy. Cyclic neutropenia is a condition in which there are cycles
where the white cell count drops. The clinical presentation of
leucopenia is known as agranulocytosis. This produces susceptibility
to infection. The dentist may be involved as oral ulceration may occur
with this condition.
Leucocytosis is a white cell count of greater than 11 × 109/L. Many

infections raise the white cell count and it is a feature of leukaemia.
Leukemia is cancer of the WBCs that affects the bone marrow and
circulating blood. It involves exponential proliferation of a clonal
myeloid or lymphoid cell and occurs in both acute and chronic forms.
Acute leukemia is a rapidly progressive disease that results from
accumulation of immature, functionless WBCs in the marrow and
blood. Chronic leukemias have a slower onset, which allows
production of larger numbers of more mature (terminally
differentiated), functional cells. The cause of leukemia remains
unknown. Increased risk is associated with large doses of ionizing
radiation, certain chemicals (benzene), and infection with specific
viruses (e.g., Epstein-Barr virus [EBV], human lympho¬tropic virus
[HTLV]-1). Cigarette smoking and exposure to electromagnetic fields
also have been proposed to be causative.
Leukemias are divided into acute and chronic forms. Two types of
acute leukaemia and two kinds of chronic leukaemia are recognised.
These are:
• Acute lymphoblastic leukaemia (ALL)
• Acute myeloblastic leukaemia (AML)
Dr. Ahmed Torki 1 of 3 September 30, 2023

• Chronic lymphocytic leukaemia (CLL)

• Chronic myeloid leukaemia (CML)
Acute lymphoblastic leukaemia (ALL) is the commonest presentation

in children. The prognosis in children with ALL is better than that for
adults for whom the long-term survival is low. Acute myeloblastic
leukaemia is more common in adults compared to children. The
prognosis for both adults and children is poor. The treatment for the
acute leukaemias is with cytotoxic drug therapy or bone marrow
transplantation. The chronic leukaemias involve the proliferation of
more mature cells than those found in the acute conditions. The
prognosis is better than for the acute leukaemias, and adults are more
commonly affected than children. Chronic lymphocytic leukaemia
(CLL) is the more common form. Some patients with this condition
are asymptomatic. The disease may present with splenomegaly (an
enlarged spleen) and lymph node enlargement. Chronic myeloid
leukaemia (CML) affects adults of a slightly younger age group than
CLL. Splenomegaly occurs but lymph node enlargement is not as
common as with CLL. Treatment is with chemotherapy and
radiotherapy.
Oral manifestations of leukemia

• Gingival swelling/ enlargement
• Mucosal or gingival bleeding
• Oral infection and mucositis.
• Delayed healing.
Lymphoma is cancer of the lymphoid organs and tissues that presents

as discrete tissue masses. Lymphomas represent the seventh most
common malignancy worldwide. These diseases are of importance in
dental management because initial signs often occur in the mouth.
Lymphomas are divided into two types:

• Hodgkin’s
• Non-Hodgkin’s
Hodgkin’s lymphoma mainly affects males with the peak incidence in

the fourth decade of life. It presents as lymph node enlargement. This

enlargement often occurs in the neck. Non-Hodgkin’s lymphomas

have a poorer prognosis than the Hodgkin’s type. Whereas Hodgkin’s
can be centred on one node, non-Hodgkin’s is usually multifocal.
Burkitt’s lymphoma is a condition associated with the Epstein- Barr
virus and may present in the jaws. Treatment for the lymphomas is
with combined chemotherapy and radiotherapy.
Oral manifestation of lymphomas

• Extranodal oral tumors in Waldeyer’s ring or osseous soft tissues.
• Xerostomia in patients treated by radiation; some of these patients
prone to osteonecrosis.
• Burning mouth or tongue symptoms
• Petechiae or ecchymosis if thrombocytopenia present because of
tumor invasion of bone marrow.
• Cervical lymphadenopathy.
• Mucositis in patients treated by radiation therapy or chemotherapy.
Multiple myeloma (MM) is a lymphoproliferative disorder that results

from overproduction of cloned malignant plasma cells that results in
multiple tumorous masses scattered throughout the skeletal system.
Treatment is with chemotherapy. Occasionally an isolated lesion (a
plasmacytoma) may occur in the jaws; these are treated by
radiotherapy.
Oral manifestation
• Soft tissue tumors
• Osteolytic lesions
• Amyloid deposits in soft tissues
• Unexplained mobility of teeth
• Exposed bone.

002 Medicine

Uploaded by

Copyright:

Available Formats

002 Medicine

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

002 Medicine

Uploaded by

Copyright:

Available Formats

General Medicine#3&4 WBCs Disorders

Disorders of white blood cells (WBCs) in the dental patient can

Leucopenia is a white blood cell count of less than 4.0 × 109/L. It

Leucocytosis is a white cell count of greater than 11 × 109/L. Many

Dr. Ahmed Torki 1 of 3 September 30, 2023

• Chronic lymphocytic leukaemia (CLL)

Acute lymphoblastic leukaemia (ALL) is the commonest presentation

Oral manifestations of leukemia

Lymphoma is cancer of the lymphoid organs and tissues that presents

Lymphomas are divided into two types:

Hodgkin’s lymphoma mainly affects males with the peak incidence in

Dr. Ahmed Torki 2 of 3 September 30, 2023

enlargement often occurs in the neck. Non-Hodgkin’s lymphomas

Oral manifestation of lymphomas

Multiple myeloma (MM) is a lymphoproliferative disorder that results

Dr. Ahmed Torki 3 of 3 September 30, 2023

You might also like