Gingival hyperplasia as first clinical sign of acute myeloid leukemia (AML)

OBJECTIVES The increase in gingival volume as first clinical manifestation of onco-haematological pathology in otherwise asymptomatic patients if correctly recognized and if a correct differential diagnosis path is set up can lead the dentist to assume the role of first diagnostician. MATERIALS AND METHODS A 62-year-old female patient presented complaining of widespread and persistent pain at the gums, which had been going on for a few weeks. The patient also reported a recent 4-month hospitalization for Sars-CoV 2. At the intra-oral objective examination, swelling and gingival edema were observed which were diffuse and painful to palpation, of a purplish-red color with presence of dental plaque above and below the gingiva. RESULTS AND DISCUSSION The patient was prescribed haematochemical evaluations, performed an incisional biopsy and finally second-level haematological evaluation by bone marrow sampling from the hip. She was diagnosed with acute myeloid leukemia (AML). CONCLUSIONS The most common oral manifestations of leukemia may include petechial hemorrhages of the tongue, lips, hard and soft palate (primarily posterior), gingival hyperplasia, and spontaneous gingival bleeding. CLINICAL SIGNIFICANCE Acute myeloid leukemia (AML) frequently presents with oral manifestations as the first clinical signs of the disease; therefore, oral health professionals should never underestimate the clinical sign of spontaneous non-specific, non-plaque related and/or sudden onset gingival bleeding.