Gingival enlargement Gingival enlargement can have various causes. For example,acute or chronic infection may cause enlargement involving mainly marginal andinterproximal gingiva. Specific drugs such as calcium channel blockers,phenytoin, and cyclosporine are associated with gingival enlargement. Moreimportantly, gingival enlargement may be an early manifestation of underlyingsystemic disease, such as acute leukemia.
(C)Diffuse, boggy gingivalenlargement is especially associated with the monocytic variety (A) Histologically, the lesionsconsisted of extravasated and proliferating monocytoid or myeloid cells and regionalblood vessels are compressed by the infiltrate (D) Gingival infiltration represents a 5% frequency as the initialpresentation complication of AML. (BOOK1) In retrospective study of 1076 patients with acute leukemia acutemonocytic leukemia had the greatest incidence of gingival infiltrates (66.7 %)followed by acute myelomonocytic leukemia (18.5 %) and acute myeloblastic leukemia (3.7 %). (D) Gingival enlargement in leukemicpatients is known to disappear without any specific periodontal treatment afterchemotherapy.
However, enlarged gingiva facilitates plaque accumulation whichmay lead to gingival inflammation with secondary gingival swelling. Gingivalenlargement does not generally develop in edentulous patients. (C, D, E) In retrospective study of 477 children with AML the presence of extramedullary infiltrates atdiagnosis had no significant effect on eventfree survival. In a stepwisemultiple regression analysis only favourable cytogenetic findings remainedsignificant.
(G)Granulocyticsarcoma (chloroma) is a localizedextramedullary tumor composed of immature cells of the granulocytic series wasobserved with AML and also with the onset of blast crisis in CML. Choroma may precede themanifestations of AML by months or years on variety of sites including the skin, lymphnodes, gingiva, bone, soft tissue, and visceral organs. (13) Chloroma of the oralcavity