ALLERGIC DISEASES OF ORAL MUCOSA Allergy is the perverted reaction of an organism to ...

60 Pages·2017·0.7 MB·English

ALLERGIC DISEASES OF ORAL MUCOSA
Allergy is the perverted reaction of an organism to certain substances of the antigenic nature which
in norm do not cause the painful phenomena. Endocrine and nervous systems, and also pathology of
a gastroenteric tract play important role in allergy occurrence. Various substances can become the
allergy reason: simple and difficult chemical compounds (iodine, bromine, proteins,
polysaccharides) which getting into an organism, cause development of humoral and cellular
immunologic reactions (an inflammation, a spastic stricture of bronchial muscles, a necrosis, a
shock etc.).
The substances causing development of allergic reactions are called allergens. The quantity of
allergens in the nature is great enough, they are very various, both on structure, and on properties.
According to origination the allergens are divided to exogenous and endogenous. Exogenous
allergens get into an organism from the outside, and endogenous are originated in the organism and
are own, but modified proteins. Thus, endogenous allergens are auto allergens.
Exogenous allergens are:
-Infectious - microbes, fungi, viruses, Chlamydia, protozoa
-Non-infectious - vegetative, medicinal, alimentary, household, industrial etc.
Endogenous allergens are:
- Natural, or primary-some structures of an organism (a lens, a thyreoglobulin, etc.) which in
norm do not cause the immune reaction of an organism
- Acquired, or secondary - are formed in an organism during disturbances of metabolic
processes under the influence of any pathological infectious or non- infectious factors (a cold,
radiation, burns etc.).
In a current of allergic reactions three stages are distinguished:
1) immunologic
2) biochemical (pathochemical)
3) pathophysiological
The immunologic stage begins with organism and allergen contact, which result in organism
sensibilization that is origination of the antibodies which are capable to co-operate with the given
allergen. If after that allergen leaves from an organism no pathological reactions occur. Thus, the
first penetration of allergen into an organism has sensitizing influence.
In case of repeated entrance of allergen in already sensitizing organism allergen-antibody or
allergen-sensitizing lymphocyte complex is formed.
The stage of allergic reaction which is characterized by development or emission of
biologically active substances - BAS, allergy mediators (Histamine, serotonin, etc.) begins with this
moment and pathochemical.
The pathophysiological stage of allergic reaction or stage of clinical features is a result of BAS
influence on tissues and organism organs. It is a stage of clinical implication of an allergy: blood
circulation disturbances, spasm of bronchial and intestinal muscles, changes of structure of blood
serum, disturbance of coagulability of blood etc. are characteristic.
Based on the development mechanism following allergic reactions are distinguished:
1) immediate type
2) cytotoxic
3) reactions of Artuse phenomenon type (immune complexes)
4) slowed down type (cellular hypersensitivity)
Each of these types of allergic reaction has the special immune mechanisms, and the mediators
that cause features of a clinical current of allergic diseases.
1) Allergic reactions of the first type are called also anaphylactic or atopic. They develop
during interaction of an antigen with antibodies of type IgE and IgG which are called reagents. IgE
and IgG are adsorbed on tissue basophiles and fat cells. Interaction of an antigen with reagents
causes degranulation of the basophiles and fat cells. As a result, in intercellular space there is an
emission of mediators of an allergy being inside these cells: Histamine, heparin, serotonin,
prostaglandin (PG). Clinical features of an allergy of this type begin in 15-20 minutes after contact
of an organism to allergen; therefore they are called reactions of immediate type.
Anaphylactic shock, urticaria, bronchial asthma, hay fever etc concern to reactions of
immediate type.
2) Allergic reactions of the second type (cytotoxic) - are characterized by formation of
antibodies IgG and IgM, capable to activate a complement. In case of this type of reaction the
antigen is a component of a cell or is adsorbed on it, and the antibody arrives in a tissue. Adhesion
of antibody with an antigen causes complement activation, cell destruction, a phagocytosis and
excision of the blasted cells and tissues.
Medicinal allergies concern to reactions of cytotoxic type.
3) Allergic reactions of the third type (immune complexes) during which neither the antigen,
nor an antibody are not a component of cells, and formation of an antigen-antibody immune
complex occurs in blood and an intercellular liquid. In case of this type of reaction antibodies are
IgG and IgM as well. Immune complexes settle down around vessels and in a vascular wall. It leads
to disturbance of microcirculation and a secondary lesion of tissues, up to a necrosis.
Autoallergic diseases concern to reactions of immune complexes (lupus erythematosus, etc.)
4). Allergic reactions of the fourth type (slowed down type) are characterized by T-
lymphocytes co-operation with antigens. These T-lymphocytes have the receptors on the membrane
capable to contact with antigen. When T-lymphocyte is joined to allergen, the mediator of cellular
immunity - lymphokines is formed. About 30 various lymphokines are known by means of which T-
lymphocytes become organizers of destruction of antigens by other leucocytes of blood.
Lymphokines cause a clump of macrophages therefore the inflammation develops and the
phagocytosis is carried out.
Allergic reactions of the slowed down type develop in 24-48 hours after contact of allergen to
an organism. Reactions of such type underlie almost all virus and bacteriemic infections
(tuberculosis, syphilis etc.).
Diagnosis:
Diagnosis of allergic diseases is based on the allergological anamnesis, diagnostic and
laboratory tests.
During subjective examination (allergological anamnesis) the contacts with various household
and industrial substances, predisposition of an organism to allergies, possible reasons of allergies
should be taken into account.
Diagnostic tests should be done in 2-3 weeks after acute implication of an allergy. Dermal tests
are done: to find out a medicinal allergy - by means of application on a skin, allergy of a bacteriemic
or fungal origination - an intradermal method.
Reaction of basophiles degranulation (test of Sheili), and reaction of leukocytosis are concern
to laboratory tests.
Anaphylactic shock Anaphylactic shock (choc anaphylacticus) is the generalized
anaphylactic reaction originating during interaction of the entered antigen with cytophilous
antibodies. Anaphylactic shock is the highest step of implication of allergic reaction of immediate
type.
In dental practice anaphylactic shock can occur from anesthetics, analgesics, antibiotics,
filling materials, including root channels sealers, impression materials etc.
Clinical features:
Anaphylactic shock develops suddenly, in some minutes, and even immediately after antigen
introduction. The patient shows anxiety; has a feeling of fear, fever, and constraint in a breast. There
are complicated breath, at first frequent, and then convulsive, nausea, vomiting, plentiful
diaphoresis, hyperemia of integuments, headache, pulsation in head. Pupils extend and do not react
to light. These symptoms are replaced by balance loss, falling, cramps. Spontaneous urination and
defecation occur. Changes of cardiovascular system: tachycardia, threadlike pulse, sharp falling of
arterial pressure- are characteristic for anaphylactic shock.
Anaphylactic shock is not shown on oral mucosa.
Differential diagnosis:
The anaphylactic shock is necessary for differentiating from:
- An acute heart insufficiency
- A myocardial infarction (heart attack)
- Epilepsies
Treatment: The outcome of an anaphylactic shock depends on severity of symptoms less, than
on complete and on time treatment.
First of all it is necessary to stop allergen introduction in an organism. Horizontal position is
given to the patient; prostheses should be removed from an oral cavity, and a mandible should be
pushed forward and fixed in this position to prevent tongue asphyxia.
0,5ml of 0,1 % adrenaline solution or 2-4ml of 0,2 % epinephrine solution should be injected
subcutaneously or intramuscularly (in serious cases intravenous introduction is prescribed) to
increase arterial blood pressure.
For bronchospasm cupping use 5-10ml of 2,4 % euphilinum solution intravenously.
In case of cramps tranquilizers and neuroleptics (Seduxenum, Elenium) are used.
Angioneurotic Quincke's edema Quincke's edema (oedema angioneuroticum Quinke) is
promptly developing deep edema of the limited part of skin, connective tissue and mucosa which
has a sudden onset; can spontaneously disappear and again be shown.
For the first time this disease was described by German therapist Quinke.
In case of angioneurotic edema the BAS deactivation and inhibition system is broken. It
develops in case of hereditary deficiency of these inhibitors, disturbance of function of the organs
deactivating BAS. Activation of BAS is very easily for these patients. This activation can be caused
not only by a complex of antigen-antibody, but also by non-immune agents (for example, a cold).
Under the influence of BAS there is an exit of an exudate and an edema of tissues.
Clinical features: Disease begins sharply, within several minutes there is a limited expressed
edema. The edema basically is localized in the field of lips, eyelids, external genitals, tongue and a
larynx. Colour of a skin in the field of an edema is not changed, tissues are strained, but the fossa is
not formed during palpation which is painless. Edema presents from several hours till two days and
disappears completely without any changes. In case of tongue edema it is hardly located in an oral
cavity. The edema of tongue and larynxes are the most dangerous, as can lead to development of a
stenosing asphyxia. If the Quincke's edema is located in cerebral covers there are neurologic
disturbances (epileptic attack).
There are periodic remissions during this disease, which is not accompanied by painful
sensations, patients complain of feeling of tension in tissues more often.
Differential diagnosis: Quincke's edema localized in lips is necessary to distinguish from:
- A cheilitis granulomatosa (syndrome Melkersson-Rosenthal)
- An erysipelatous inflammation of lips
- A collateral edema of lips and a lymphostasis during periostitis
In case of Melkersson-Rosenthal syndrome the edema of lips is combined by fissured tongue
and neuritis of a facial nerve.
In case of erysipilatous inflammation of lips the affected part is hyperemic, and in case of
Quincke's edema - is not changed in colour.
Treatment: First of all stop contact to allergen.
Antihistamine drugs (Dimedrol, Suprastinum, Tavegilum) are prescribed intramuscularly, and
in easy cases in the form of tablets 2-3 times a day. For reduction of permeability of vascular walls
Ascorutinum is prescribed. During edema of larynxes 25 mg of prednisolone is intramuscularly
entered, and in case of need the patient should be taken in a hospital for tracheotomy carrying out. In
serious cases 0,1-0,5ml of 0,1 % adrenaline solution is subcutaneously entered for blood pressure
increase.
CHANGES OF ORAL MUCOSA IN CASE OF HYPO - AND AVITAMINOSIS

Vitamins play the important role in organism vital activity. They accept active participation in
metabolism processes. The basic source of vitamins is food, synthesis of some of them is partially
carried out by an intestine microflora, and still the part is formed from provitamins in an organism.

The hypovitaminosis is a condition which comes in case of insufficient entering of vitamin in
an organism or disturbance of its absorption.

The avitaminosis is full absence of any vitamin in an organism. At present the avitaminosis
practically is not met.

Depending on the mechanism of development of vitamin insufficiency we distinguish some
kinds of hypo-and avitaminosis:

1) Alimentary - occurs in case of insufficient entering of vitamins with nutrition

2) Resorptive – originates in case of destruction of vitamins in gastroenteric tract, disturbance
of their absorption and synthesis by an intestinal microflora

3) Dissimilative – occurs in case of disturbance of vitamins metabolism which is a
consequence of the general metabolism.

Vitamin В (Thiamine) - is synthesized in a human body, and also entered with nutrition. After
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an absorption in thin intestine it turns to a cocarboxylase.

Physiological value - regulates metabolism processes, in particular carbohydrate and protein
metabolism. Besides, vitamin В takes part in transfer of nervous impulses and in hemopoiesis.
1
Daily requirement of an organism for vitamin В is 2-3 mg.
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Hypovitaminosis of В in an oral cavity does not cause certain specific changes. It is used
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during treatment of neuritis and neuralgias of n.trigeminus, periodontal diseases, oral pathologies of
various etiologies.

Producing forms: - each tablet and dragee contain 0,002 g and 0,01g

- Solutions for injections- 3 % and 6 %

Vitamin В (Riboflavin) – is entered in an organism with nutrition, and also is synthesized in
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an intestine and collected in a cerebral tissue, a liver, kidneys and heart.

Physiological value - participates in oxidation-reduction reactions and a metabolism.

Daily requirement of an organism for vitamin В is 2,5 (2-3) mg.
2
Hypovitaminosis of vit В causes the changes of oral mucosa and an eye. Cracks (fissures)
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covered by squama (crusts) are thus formed in mouth angles. Dryness, peeling and reddening of lips,
formation of vertical fissures become perceptible. Crusts occur on nose wings nasal-labial folds as
well. Tongue papillae are atrophied, there are a hyperemia and the aphthous changes, patients note a
burning sensation and a pain.

Changes on oral mucosa are accompanied by lesions of eyes: dacryorrhea a keratitis, cornea
turbidity.

Hypovitaminosis of vit В is diagnosed by decrease of its quantity in urine and blood.
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In stomatological practice Riboflavin is used in case of glossitis, cheilitis, allergic diseases.

Output forms: - each tablet contains 0,05 g

- A solution for injections- 1 %

Vitamin В (pyridoxine) - is synthesized by bacteriemic flora of an intestine.
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Physiological value - is a biocatalyst of metabolic processes, stimulates formation of
hemoglobin and leucocytes, promotes development of natural immunity due to increase of
phagocytic activity of leucocytes.

Daily requirement of an organism for vitamin В is 2-4 mg.
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Hypovitaminosis of vit В causes occurrence of angular stomatitis, cheilitis and glossitis.
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In stomatological practice the pyridoxine is used during treatment of medicamental stomatitis,
glossitis, cheilitis.

Vitamins В and В is inexpedient to prescribe together for parenteral taking as their
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biological activation becomes difficult in an organism.

Producing forms: - each tablet contains 0,002, 0,005 and 0,01g

- Solutions for injections- 1 %, 2,5 % and 5 %
Vitamin В (cyanocobalamin) - is entered in an organism with nutrition where it is soaked up
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in a stomach with the assistance of intrinsic factor of Castle (gastromucoprotein) which is developed
in a stomach.

Physiological value - provides normal maturing of bloody elements in bone marrow, and,
besides, raises phagocytic activity of leucocytes, production of antibodies, activates protein
synthesis.

Daily requirement of an organism for vitamin В is 2-3 mg.
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Hypovitaminosis of vit В causes development of Addison-Birmer anemia (В -deficiency
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anemia). The initial symptoms of this anemia are the tongue lesions: a burning sensation, a pricking,
occurrence of a hyperemia and an atrophy of papillae - the "polished" tongue. Dryness in a mouth
(xerostomia) simultaneously becomes perceptible. Later the pain in tongue while eating is added to
these symptoms.

Anemia of Addison-Birmer is diagnosed by means of the blood analysis (blood chemistry)
where reduction of quantity of erythrocytes and hemoglobin is observed. And the quantity of
erythrocytes decreases faster quantity of hemoglobin; therefore this anemia has hyperchromatic
character.

In dental practice cyanocobalamin is used during treatment of neuralgia of n. trigeminus,
tongue paresthesia, lupus erythematosus.

Producing forms: - each tablet contains 100-200 mcg.

Vitamin В is usually used in a complex with other B vitamins.
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Vitamin РР (nicotinic acid) - - is entered in an organism with nutrition.

Physiological value - participates in metabolism of the carbohydrates, proteins and other kinds.

Daily requirement of an organism for vitamin РР is 15-25 mg.

Hypovitaminosis of vit РР is shown in the form of tongue edema in an oral cavity. Tongue is
enlarged in size, becomes bright red; papillae are hypertrophic in the beginning, then they are
smoothed out.

In dental practice nicotinic acid is used during treatment of rubber lichen planus, periodontal
diseases, cheilitis, etc.

Producing forms: - each tablet contains 0,05 g

- Solution for injection 1 %

Vitamin C (Acid ascorbic) - is entered in an organism with nutrition.

Physiological value - vitamin C is necessary for normal realization of the vital processes. It
participates in collagen synthesis, protein metabolism, regulates permeability of walls of blood
vessels and makes active impact on resistance of an organism to an infection.

Daily requirement of an organism for vitamin C is 70-80 mg.

Hypovitaminosis of vit C in an oral cavity is shown always. First of all there is profuse gingival
bleeding and hemorrhages on oral mucosa. In case of advance of vit C hypovitaminosis gingivitis
passes in the ulcerative form. The general condition of the patient suffers: there is vivid asthenia,
fast fatigability, pains in calf muscles.

In dental practice vitamin C is used very widely: during treatment of periodontal diseases and
oral pathologies.

Acidum ascorbinicum is desirable for prescribing with vitamin Р (Rutin) which is a synergist
of vitamin C and strengthens its action.

Producing forms: - each tablet of vitamin C contains 0,05 g and 0,1g, each tablet of vitamin C
and Rutin - "Ascorutin" - contains 0,05g

- Solution for injection 5 %

Vitamin A (Retinol) - is entered in an organism with nutrition.

Physiological value - vitamin A is necessary for growth of an organism, maintenance of a
normal condition of a skin and mucosa, raises protective properties of oral mucosa to various
traumatic factors.

Daily requirement of an organism for vitamin A is 1,5mg.

Hypovitaminosis of vit A in an oral cavity is shown by hyperkeratosis symptoms, dryness of
skin and oral mucosa.
In dental practice Retinol is used during treatment of Leukoplakia, rubber lichen planus, for
acceleration of epithelization processes in case of many oral pathologies and as a basis for a medical
bandage during periodontal diseases treatment.

Producing forms: - each dragee contains 10000-25000 ME

- Solutio oleosa for intake (taking peroral) and intramuscularly injections

Vitamin E (tocopherol acetate) - is entered in an organism with nutrition.

Physiological value - vitamin E is an antioxidant, promotes accumulation of vitamin A and
other fat soluble vitamins, improves a fatty and mineral metabolism.

Daily requirement of an organism for vitamin E is 10 - 25 mg.

Hypovitaminosis of vit Е in an oral cavity is not shown by any specific signs.

In dental practice tocopherol acetate is used with vitamin A during treatment of parodontitis
and for applications on erosions and ulcers in case of oral pathologies.

Producing forms: - dragee and Solutio oleosa, a dragee "Aevit" - vitamins A and Е.

CHANGES OF ORAL MUCOSA DURING EXOGENOUS INTOXICATIONS

Exogenous intoxications of an organism are possible during toxic action of medicines,
professional harmfulnesses. Thus intoxications from medicines are possible only during their
overdosage, in the result of disturbance of function of secretary organs.

Toxic action of medicines needs to be distinguished from a medicinal allergy.

In case of medicinal intoxication for each medicament the specific picture of a lesion is
characteristic, and poisoning degree depends on a medicine dose in an organism. Thus the
antibodies are not developed, and during treatment antidotes, bathing are used.

In case of medicinal allergy the clinical picture and its severity do not depend on a type and a
dose of medicine. In an organism antibodies are formed, and during treatment antiallergic medicines
(antihistamine, etc.) are used

Intoxications from mercury and bismuth medicaments

Intoxications from mercury medicaments cause the general and local changes. The general are
disturbances of nervous system and a gastroenteric tract, and local - various changes of oral mucosa
from discoloration till necrotizing ulcerative lesions.

Intoxications from bismuth medicaments (biochinol, bismoverolum, etc.), cause a lesion of
oral mucosa in the form of a discoloration. On gingival margins, and sometimes and on other parts
of oral mucosa there is a bismuthic border of grayish or black colour.

In case of intoxications from medicaments of both mercury and bismuth painful sensations are
present only in case of disturbance of integrity of a mucosa, and in case of necrotizing ulcerative
lesions there is an unpleasant smell from a mouth.

Intoxications from lead

Lead intoxications is met among people, in working time contacting to lead (lead extraction,
type-setters in printing house).

In case of mild form while poisoning from lead there is a grey border on gums, maculae are
rarer. In more serious cases, during long contact to lead, there are hearths of an aseptic necrosis as
lead, being accumulated in walls of vessels, causes blood supply disturbances.

Except of oral mucosa the skin is affected also - there are erythema and bulla on it.

In serious cases anemia, neurosis, paralyses and nephropathies can develop.

For treatment antidotes (Unithiolum, Succimerum, etc.), a solution of potassium iodide,
vitamins C and В are used.
1
Locally: oral cavity sanitation (as presence of carious cavities and dental deposits promotes
more serious current of a poisoning) is carried out. Mucosa is processed by 1 % solution of acetic
acid which dissolves a lead dust.

Intoxications from mercury

Mercurial intoxications are found out among workers of mercurial manufactures and occur in
case of inhalation of steams of mercury.

The general symptoms of intoxication are: irritability, depression of memory, working
capacity.
In an oral cavity the poisoning is shown in the form of a border of black colour on marginal
gingiva. There are gingival bleeding, necrotizing ulcerative lesions which can extend on other sites
of oral mucosa. Patients can note unpleasant metal taste in a mouth, a hypersalivation.

Treatment is referred on the termination of entering of mercury and its deducing from an
organism. For this purpose prescribe plentiful alkaline drink, taking Sodium thiosulfate solution,
injection of Unithiolum which forms insoluble bonds with heavy metals, polyvitamines.

Locally: oral cavity sanitation, antiseptic processing of oral mucosa is done as well, in case of
ulcerative lesions- application of keratoplastics.
Condition of the OCMM during blood and hematopoietic system diseases

According to actual representations, in the etiology and pathogenesis of parodont
and oral mucosa diseases a great value have the diseases of inner organs and organism
systems.
Among the general diseases, accompanied by oral cavity disorders, the diseases of
hematopoietic system have a special place. All the disorders of hematopoiesis first of
all are shown on the oral membrane. Hence, the stomatologist can be the first, who
can diagnose the general diseases, and render a special professional approach in the
treatment of such patients.

1. Diseases of red blood
Fe-deficiency anemia develops in case of disorders of Fe ions absorption, long
lasting bleedings, anacid gastritis, chronic infections etc. Disease is more often
observed in the age of 30-40 years, develops slowly and has a chronic current. In
peripheral blood of the patient deficiency of erythrocytes within the bottom borders of
norm is found out. The color indicator is less than 1(approximately 0.7).
Patients complain on weakness, dizziness, headaches, restless sleep, fast fatigue,
disorders of sensitivity of separate areas of the skin, especially on fingers. Disorders
of gastrointestinal and cardiovascular systems are often observed. The skin of the
patient is pale. Trophy changes of the skin, nails and in the area of the scalp can be
found out.
Oral mucosa is pale. Patients often complain on disorders of sense of smell and
flavor. It is shown by appetite loss, use of inedible products (chalk, tooth-paste, sand
etc.), and also by feeling of burning and paresthesia of tongue, especially on tip.
Salivation is decreased, which leads to dryness of the OCMM and constant
requirement for drink.
Often in the mouth corners painful cracks and angular stomatitis are formed.
Catarrhal gingivitis, and in heavy cases, parodontitis are observed, accompanied by
bleedings of various degrees.
During objective examination tongue edema, atrophy of tongue papillae is
observed. Tongue body is hyperemic. In heavy cases all papillae of the tongue
become atrophic; tongue becomes shiny (like the Gunter-Moeller’s glossitis).
The teeth are affected by chronic caries, enamel loses the shine, the teeth become
fragile, pathological abrasion of tooth hard tissues is observed.
В vitamin-deficiency anemia (Addison-Birmer’s anemia). The lack of vitamin
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В is the reason of this disease. Disorder of synthesis of “Castly’s internal factor”
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leads to disorder of vitamin В absorption, which can cause В vitamin-deficiency
12 12
anemia.
Generally women of more than 40 years old are affected. The quantity of
erythrocytes is decreased; the color indicator is more than 1.
Patients complain on general weakness, dizziness, headaches, nausea, pains in the
area of heart. The skin is pale, in some places it is pigmented.
In the oral cavity the first signs are the neurologic changes of the tongue, patients
complain on feeling of burning and pain, disorder of flavor sensitivity. The tongue
papillae quickly become atrophic, the tongue becomes shiny, bright red spots
appeared on the tongue body (Gunter-Moeller’s glossitis). Sometimes petechias and
eckchimosis appear on the cheeks and lips. Often gingivitis and parodontitis are found
out, accompanied by gingival bleedings.
Caries of the teeth have fast current.
Erythremia (Vakez’s disease) is characterized by hyperplasia of all cells of
hematopoietic system.
The reason of the disease is not found out. People of more than 30 years old are
affected generally.
Patients complain on dizziness, insomnia, general weakness and headaches. Often
there is a noise in the ears and appearance of "points" in front of the eyes.
During examination dark red color of the skin is observed. Bleedings from nose,
gastrointestinal bleedings, and bleedings connected with urinogenital system are
observed. The liver and the spleen are increased, arterial pressure is high.
In peripheral blood the quantity of erythrocytes, platelets and leukocytes is
increased, the quantity hemoglobin is also increased. The blood volume is increased
up to 10-15 liter.
The changes of the oral cavy t are generally connected with darkening of the color
of mucous membrane, it gets a cherry shade. The hard palate remains pale and differs
from bright red soft palate (Cooperman’s symptom). Gingival bleedings, basically, of
the traumatic nature are possible.
Surgical interventions, especially removal of the teeth, can lead to hard stopped
bleedings.

2. Diseases of white blood
From the diseases of white blood leukemia meets more often.
Leukemia is displayed by swift hyperplasia of leukocytes. By the current leukemia
can be acute and chronic. The acuity of leukemia depends on the speed of process and
qualitative signs of leukocytes in peripheral blood.
Acute leukemia.
Depending on the type of the cells, the following forms of acute leukemia are
distinguished: lymphoblastic, myeloblastic, monoblastic, promyelocytic and non-
differentiated. Acute leukemia generally meets at young age, till 40 years old.
Acute leukemia has unexpected beginning, fast current and is often similar to other
diseases: flu, pneumonia, quinsy, etc.
Patients usually complain on general weakness, fast fatigue, pallor, bone pains,
disposition to sweating, recurring sub-febrile temperature.
During objective examination displays of hemorrhagic diathesis are found out on
the skin of the patients: petechias, hemorrhages, eckchimosis, nasal, uterine and
gastrointestinal bleedings. Also ulcerative-necrotic complications are observed:
necrotic quinsy, pleurisy, pneumonia, ulcers and areas of necrosis in the oral cavity
and in the field of organs of urogenital system.
Displays of leukemia in the oral cavity can be divided into 3 groups: hemorrhagic,
ulcerative-necrotic and hyperplastic.
Hemorrhagic symptom, first of all, is displayed by gingival bleedings. Very often
this can be the first and the only sign of leukemia for a long time. Besides,
intramucous bleedings are characteristic for leukemia: petechias, eckchimosis,
hematomas and hemorrhagic spots. After bleeding erosion and ulcers are formed on
their places. The bleeding can begin even from insignificant damage: cleaning of the
teeth, hard food eating, medical manipulations.
Often ulcerative-necrotic processes prevail at the patients. The depth and spreading
of these processes testify about exacerbation of the general process. Necrosis and
ulcers begin from marginal gingiva and extend on the other areas of the oral cavity.
Depending on the depth of the affection erosion and ulcers can be:
- Superficial - aphtae (erosion) with hyperemic ring around it, covered by white
fibrin membrane, which cannot be removed
- Deep - clean, painful ulcers which often bleed.
Erosion and ulcers are often settled down on the most traumatic areas of the
mucous: cheeks, on the line of teeth closure, lateral surfaces of tongue, in the area of
incorrectly filled teeth and artificial constructions. In the tissues, surrounding ulcers,
inflammatory reaction is absent. Regional lymph nodes are increased, sometimes are
painful.
The hemorrhagic symptom is often combined with ulcerative-necrotic one and
hypertrophy of the gums. The combination of all three symptoms (bleeding, ulcers
and hypertrophy of gums) is defined as “leukemic stomatitis”.