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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Oral Manifestations

Hematologic Disorders
Hematologic disorders include:

  • Anemia
    Iron, B12, or folate deficiency can result in anemia and changes in the oral mucosa. Oral manifestations include mucosal pallor, angular cheilitis, and atrophic glossitis or “bald tongueâ€� caused by atrophy of the lingual papillae. Atrophic glossitis triggers pain, tenderness, and burning.
  • Leukemia
    Leukemia may present with paleness of the oral mucosa, gingival bleeding, oral petechiae, painless gingival hyperplasia, and ulcerative necrotic lesions. Be especially concerned about spontaneous gingival bleeding in the absence of plaque, caries, calculus or trauma.

    Oral manifestations can be the presenting clinical signs of leukemia at disease onset, especially with Acute Myelogenous Leukemia (AML). However, Acute Lymphocytic Leukemia (ALL) is the most common of the childhood cancers, so this is the most likely disease you will encounter.

    Common oral effects from cancer treatment include:

    • Gingivitis and mucositis secondary to chemotherapy, radiation, or opportunistic infection
    • Preventive protocols to improve hygiene and prophylaxis against infection can minimize complications
  • Langerhans Cell Histiocytosis
    Alveolar bone invasion by histiocytes commonly occurs in the mandible and may result in:   
    • Pain, loose teeth, and jaw fracture.
    • X-ray appearance of teeth “floating in airâ€� due to radiolucent areas in the bone.
    • Precocious eruption or exfoliation of primary teeth (early tooth loss).  
      Exfoliation: The shedding of a superficial layer of a tooth.

    Histiocytosis can also cause gingivitis and oral ulcers

Fast Facts
Many systemic conditions are known to adversely affect the mouth or teeth, and these patients require additional oral care and management.
Oral findings may be the only presenting symptom for leukemia and histiocytosis.
Early tooth loss, especially mandibular molars, should prompt consideration of Langerhans cell histiocytosis.
Xerostomia may occur in SLE, Sjogren's Disease, and Diabetes Mellitus.
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