Darling MR, Schneider JW, Phillips VM. Polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma: a review and comparison of immunohistochemical markers. Oral Oncol 2002;38:641–645.
Laskaris G. Color Atlas of Oral Diseases. 3rd edition. Thieme Verlag: Stuttgart, 2003.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology, 2nd edition. WB Saunders Co.: Philadelphia, 2002.
Agranulocytosis
Agranulocytosis is a hematologic disorder characterized by a severe reduction or absence of granulocytes, in particular, the neutrophils (<500/mm3).
Agranulocytosis may be caused by drug treatment and infections, although some cases are idiopathic.
Oral lesions mainly occur early in the disease and are common.
Oral Manifestations
•Necrotic ulcers covered by a gray-white pseudomembrane without a red halo
•Increased salivation and painful mastication are common symptoms
•Severe necrotizing gingivitis with destruction of periodontal tissues may occur
Systemic Manifestations
•Sudden chills, fever, malaise, and sore throat
•Within 12-24 hours, signs and symptoms of respiratory, and/or gastrointestinal, or other bacterial infections often develop
•Risk of infections is usually related to the degree of neutropenia
The clinical diagnosis should be confirmed by a complete blood count and bone marrow aspiration.
•Neutropenia
•Cyclic neutropenia
•Aplastic anemia
•Acute leukemia
•Infectious mononucleosis
•Wegener granulomatosis
•Acute necrotizing ulcerative gingivitis and stomatitis
Basic Guidelines
•Potential causative drug must be discontinued.
•High level of oral hygiene must be maintained.
•Any dental and gingival treatment during the acute phase of the disease should be avoided.
•The systemic treatment must be provided by a specialist.
Suggested Therapies
Topical Treatment
The use of mouthwashes such as 0.1 % chlorhex-idine gluconate and oxygen peroxide may reduce the severity of the oral lesions.
Systemic Treatment
•Systemic administration of appropriate broad-spectrum antibiotics in doses and duration proportional to the severity of the bacterial infection.
•Granulocyte-macrophage colony-stimulating factor (GM-CSF) or recombinant human granulocyte colony-stimulating factor (rhG-CSF) is effective in shortening the recovery time in patients with agranulocytosis.
References
Friedman I, Klepfish A, Miller EB, et al. Agranulocytosis in Sjögren’s syndrome: Two case reports and analysis of 11 additional reported cases. Semin Arthritis Rheum 2002;31:338–345.
Welte K, Dale D, Pathophysiology and treatment of severe chronic neutropenia. Ann Hematol 1996;72:158.
Amalgam Tattoo
Amalgam tattoo is a common pigmented lesion of the oral mucosa.
The tattoo is caused by implantation of amalgam particles in the oral mucosa.
•Gray, black, or bluish macular or papular lesion that is usually solitary, although patients may also present with multiple lesions
•The lesion may be visible radiographically as a radio-opacity, provided that the amalgam particles are large enough
The diagnosis is usually based on clinical criteria.
•Other types of tattoos
•Pigmented nevi
•Malignant melanoma
•Racial pigmentation
•Hematoma
•Addison disease
No treatment is necessary, unless aesthetics are a concern. In this case, tissue resurfacing surgery may be done.
References
Forsell M, Larsson B, Ljungqvist A, et al. Mercury content in amalgam tattoos of human oral mucosa and its relation to local tissue reactions. Eur J Oral Sci 1998;106:582–587.
Stewart CM, Watson RE, Experimental oral foreign body reactions. Commonly employed dental materials. Oral Surg Oral Med Oral Pathol 1990;69:713–719.
Amyloidosis
Amyloidosis is a rare metabolic disorder characterized by an abnormal extracellular deposition of amyloid, a fibrillar proteinaceous material, in tissues.
The etiology of amyloidosis is not fully understood.
Four major types of amyloidosis are recognized: primary, secondary, familial, and senile. Primary and secondary amyloidosis may be either systemic or localized.
The