AtlasSystemicOral Manifestations of Leukaemia

Systemic Diseases

Oral Manifestations of Leukaemia

Acute leukaemias, especially AML M4/M5, present with striking oral signs — gingival enlargement, spontaneous bleeding, pallor and ulceration — often the presenting complaint.

Subtype
AML M4/M5
Sign
Gingival enlargement + bleeding
Test
FBC + BM biopsy

§ figuresFigures (2)

Fig. 1Peripheral blood smear of acute promyelocytic leukemia, hypogranular variant. Wright's stain.

“Peripheral blood smear of acute promyelocytic leukemia, hypogranular variant, source image (3)” · Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest: None · CC0 · Wikimedia Commons

Fig. 2Peripheral blood smear of acute promyelocytic leukemia, hypogranular variant. Wright's stain.

“Peripheral blood smear of acute promyelocytic leukemia, hypogranular variant, source image (1)” · Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest: None · CC0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Oral Manifestations of Leukaemia figures pending faculty review.

§ overviewOverview

Oral changes secondary to leukaemic infiltration, marrow failure (anaemia, thrombocytopenia, neutropenia) and treatment effects.

§ clinicalClinical Features

  • 01Diffuse boggy gingival enlargement covering crowns (esp AML M4/M5)
  • 02Spontaneous gingival bleeding, petechiae, ecchymoses (thrombocytopenia)
  • 03Mucosal pallor (anaemia)
  • 04Oral ulcers, opportunistic infections (candidiasis, HSV) from neutropenia
  • 05Odontogenic infections that fail to resolve
  • 06Chloroma (granulocytic sarcoma)

§ differentialDifferential Diagnosis

  • 01Drug-induced gingival hyperplasia
  • 02HIV-associated periodontitis
  • 03Wegener granulomatosis

§ investigationsInvestigations

  • 01FBC with peripheral smear (blasts)
  • 02Bone marrow aspiration/biopsy
  • 03Flow cytometry, cytogenetics
  • 04Coagulation profile before dental procedures

§ classificationClassification

  • 01AML (M0–M7); M4/M5 highest oral infiltration
  • 02ALL — commonest childhood leukaemia
  • 03CML, CLL — oral manifestations less common

§ treatmentTreatment

  • 01Refer to haematology-oncology urgently
  • 02Delay elective dental treatment until remission
  • 03Dental screening BEFORE chemotherapy: eliminate infection foci
  • 04Chlorhexidine mouthwash, cryotherapy for mucositis
  • 05Platelet cover (≥ 50 × 10⁹/L) for extractions
  • 06Antibiotic prophylaxis if neutropenic

§ complicationsComplications

  • 01Life-threatening haemorrhage
  • 02Septicaemia from oral source
  • 03Chemotherapy-induced mucositis

§ prognosisPrognosis

Depends on subtype, cytogenetics and response to therapy.

§ examKey Examination Points

  • 01New gingival enlargement + spontaneous bleeding in adult → FBC same day
  • 02Dental clearance before chemotherapy

§ revisionQuick Revision Summary

  • 01AML M4/M5 · gingival hyperplasia · FBC + BM aspirate

§ vivaBDS Viva Questions

  • 01Pre-chemotherapy dental assessment?
  • 02Why is AML M4/M5 particularly oral?
  • 03Chloroma?

§ mcqsMCQs — Assessment (3)

Question 1

Leukaemia subtype most often causing gingival enlargement:

Question 2

Minimum platelet count for safe extraction:

Question 3

Chloroma is a:

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

  • L1 · Classification — 1
  • L6 · Textbook — 3

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

Open PubMed

Current Classification

Reference #1L1 · ClassificationWHO / Classification Verified
WHO Classification of Tumours Online — Head and Neck

IARC / WHO. IARC · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

DOI: Identifier not availablePMID: Identifier not available
View source

Histopathology References

Reference #4L6 · TextbookHistopathology References Unverified
Surgical Pathology of the Head and Neck3rd Edition

Barnes L. CRC Press · 2008

Detailed histopathological reference for head and neck diagnostic criteria.

DOI: Identifier not availablePMID: Identifier not available

Textbook References

Reference #2L6 · TextbookTextbooksRecent Verified
Oral and Maxillofacial Pathology5th Edition

Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024

Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.

DOI: Identifier not availablePMID: Identifier not available
View source
Reference #3L6 · TextbookTextbooks Unverified
Shafer's Textbook of Oral Pathology9th Edition

Rajendran R, Sivapathasundharam B. Elsevier · 2020

Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.

DOI: Identifier not availablePMID: Identifier not available

Additional sources cited on this page

  1. Cooper CL. Br Dent J 2000

Browse the full evidence library →

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.