Patients with leukemia frequently experience easy bruising and spontaneous gingival hemorrhage secondary to thrombocytopenia. Common oral findings include petechial hemorrhage of the soft palate. Leukemic patients are more prone to oral candidiasis and oral herpetic infections. Ulceration of the oral mucosa as a result of severe neutropenia, or neutropenic ulcers, occurs in leukemia due to the host's inability to combat normal oral flora. These ulcers are typically deep, punched-out lesions with a gray-white necrotic base. They occur most commonly after mucosal trauma, herpes infection, or chemotherapeutics. Acute leukemias, particularly acute monocytic forms, cause infiltration of leukemic cells into oral soft tissue, especially gingival tissue, resulting in swollen, boggy hyperplastic gingivitis. Gingival lesions can be a result of direct infiltration, as shown in Fig 234-13, due to drug toxicity, from graft-versus-host disease, or secondary to marrow or lymphoid tissue depression.47 Infiltration of leukemic cells into the periapical tissue clinically and radiographically resembles periapical inflammatory disease. 48
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