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 pa-MATERIALS AND METHODS A 62-year-old female patient presented complaining of wide-spread and persistent pain at the gums, which had been go- tients if correctly recognized and if a correct differential diagnosis path is set up can lead the den-tist to assume the role of first di-agnostician. ing on for a few weeks. The patient also reported a recent 4-month hospitalization for Sars-CoV 2. At the intra-oral objective exam-ination, swelling and gingival edema were observed which were diffuse and painful to pal-pation, of a purplish-red color with presence of dental plaque above and below the gingiva. RESULTS AND DISCUSSION The patient was prescribed hae-matochemical evaluations, per-formed an incisional biopsy and finally second-level haematolog-ical evaluation by bone marrow sampling from the hip. She was diagnosed with acute myeloid leukemia (AML). CONCLUSIONS The most common oral manifes-tations of leukemia may include petechial hemorrhages of the tongue, lips, hard and soft palate (primarily posterior), gingival hy-perplasia, and spontaneous gin-gival bleeding. CLINICAL SIGNIFICANCE Acute myeloid leukemia (AML) frequently presents with oral manifestations as the first clini-cal signs of the disease; there-fore, oral health professionals should never underestimate the clinical sign of spontaneous non-specific, non-plaque related and/or sudden onset gingival bleeding.