Signs and symptoms of Anemia and leukemia related to oral cavity

 Anemia is a condition characterized by a deficiency of red blood cells or hemoglobin, the protein in red blood cells that binds to oxygen and carries it to the body's tissues. One of the common signs of anemia is fatigue and weakness, as the body's tissues are not getting enough oxygen. Other signs of anemia can include pale skin, shortness of breath, and a rapid or irregular heartbeat.

Leukemia is a type of cancer that affects the blood and bone marrow, leading to an overproduction of abnormal white blood cells.

Oral symptoms associated with anemia can include dry mouth, sore tongue, and a burning or tingling sensation in the tongue and mouth. The gums may appear pale, and there may be small, shallow ulcers or sores on the tongue and inside of the cheeks. Anemia can also cause difficulty swallowing and a loss of taste.

In the case of leukemia, oral symptoms can include the following:

• Petechiae: Tiny red or purple spots on the gums, the roof of the mouth, and the buccal mucosa caused by bleeding under the surface of the skin.
• Gum hypertrophy: Enlarged or swollen gums
• Oral infections: Leukemia can impair the body's ability to fight infections, leading to frequent mouth sores, ulcers, and infections in the gums, tongue, and other parts of the mouth.
• Taste changes: Some people with leukemia may experience changes in their sense of taste.
• Excessive bleeding from the oral cavity
• Mouth pain
• Loose teeth

In addition to these symptoms, individuals with anemia or leukemia may also experience difficulty swallowing, sore mouth or tongue, and unexplained weight loss.

It is important to remember that these symptoms may also be caused by other conditions and to seek professional medical help to diagnose and treat them. A thorough examination of the oral cavity, together with laboratory and imaging tests, will be done by a dentist or oral surgeon to establish the diagnosis.

PGCEE MDS 2022: The dentin desensitizing agents that acts by precipitating proteins in the dentinal tubular fluid is:

 # The dentin desensitizing agent that acts by precipitating proteins in the dentinal tubular fluid is:

a) Strontium Chloride 

b) Potassium oxalate

c) Fluoride 

d) Hydroxyethyl methacrylate

The correct answer is A. Strontium chloride.

Dentin Desensitizers act by:

i) Desensitization of intradental nerves or inhibit or prevent transmission of the stimulus itself.

Eg: Potassium salts like nitrate, chloride and citrate.

ii) Occlusion of the dentinal tubules

a) Precipitation of proteins:

• Silver nitrate

• Zinc chloride

• Strontium chloride

b) Plugging of dentinal tubules

• Salts of fluorides and oxalates

• Bioglass

c) Dentin adhesive sealers

• Varnish

• GIC

• Composites

• Dentin bonding agents

iii) Lasers:

• Nd-YAG-act by occlusion of tubules

• GaAlA (Gallium Aluminium Arsenide laser act by affecting the neural transmission)

PGCEE MDS 2022: Bald tongue due to vitamin B12 deficiency is called as:

 # Bald tongue due to vitamin B12 deficiency is called as:

A. Moeller’s glossitis

B. Benign migratory glossitis

C. Strawberry tongue

D. Gingivostomatitis

The correct answer is A. Moeller's glossitis.

Pernicious Anemia, or Addison's anemia or Biermer's anemia

• Seen due to deficiency of Vit. B12 or Erythrocyte maturation factor or extrinsic factor.

• Peripheral neuropathy due to degeneration of posterior and lateral tracts of the spinal cord with loss of nerve fibers and degeneration of myelin sheath is seen.

• Tongue is "beefy red" in color and characteristically shows glossitis, glossodynia, and glossopyrosis.

• There is gradual atrophy of papillae of the tongue resulting in a "bald" tongue which is often referred to as Hunter's glossitis or Moeller's glossitis which is similar to the "bald tongue of sandwith" seen in pellagra.

 • RBC count of < 1 million, macrocytosis, poikilocytosis, polychromatophilic cells, stippled cells, nucleated cells, Howell-Jolloy bodies, and Cabot's ring are the laboratory findings.

• Bone marrow studies reveal immature red cells or MEGALOBLASTS. Polymacrocytes (macropolyps) are large polymorphonuclear leukocytes with large poly-lobed nuclei are also found.

• Achlorhydria or lack of HCL secretion is a constant feature of the disease.

• The oral and general manifestations of "sprue" are closely related to pernicious anemia.

PGCEE MDS 2022: Enzyme responsible for breakdown of ground substance is:

 # Enzyme responsible for breakdown of ground substance is:

a) Hyaluronidase 

b) Coagulase

c) Phosphorylase 

d) Acid phosphatase

The correct answer is A. Hyaluronidase.

Collagenase is responsible for the breakdown of periodontal fibers in periodontitis. It is released by bacteria (P. gingivalis mostly), polymorpho-nuclear leukocytes, and some populations of fibroblasts. Hyaluronidase causes the breakdown of ground substances and helps in the spread of inflammation (cellulitis).

PGCEE MDS 2022: Rapid maxillary expansion is not indicated after:

 # Rapid maxillary expansion is not indicated after:

a) 6 years 

b) 9 years

c) 12 years 

d) 15 years

The correct answer is D. 15 years.

Rapid maxillary expansion should be initiated prior to the ossification of the mid-palatal suture. The time of ossification of the mid-palatal suture is about 16 years in girls and 18 years in boys with a broad range of 15-27 years.

Contraindications of Rapid maxillary expansion:

• Single tooth crossbites

• In adults with severe anteroposterior skeletal discrepancies.

• Vertical growers

• Periodontally weak conditions

The retention period following rapid maxillary expansion should be at least 3 - 6 months.

In slow expansion, the maxillary arch is expanded at a rate of 0.5 - l mm per week.

The forces generated in slow expansion procedures are 2-4 pounds while it is 10-20 pounds (1 pound = 450 gms) in RME.

In rapid maxillary expansion, the treatment is completed in 1-2 weeks whereas in the slow expansion it may take as much as 2-5 months.

PGCEE MDS 2022: Gubernacular canal guides the eruption of:

 # Gubernacular canal guides the eruption of:

a) Primary teeth 

b) Permanent teeth

c) First molar

d) Third molar

The correct answer is B. Permanent teeth. 

Actually the correct answer is Succedaneous teeth. Because, not all permanent teeth have a gubernacular canal. The gubernacular canal and cord help in guiding the permanent teeth during the process of eruption. Except molars, all the permanent teeth (incisors, canines, and premolars) are known as succedaneous teeth because they take the place of their primary predecessors.

Permanent molars are not succedaneous teeth, as they develop from the distal extension of the dental lamina. Successional lamina, which is present on the lingual side of primary dental lamina, is absent for permanent molars.

PGCEE MDS 2022: Chronic burrowing ulcer is caused by:

 # Chronic burrowing ulcer is caused by:

a) Microaerophilic streptococci

b) Peptostreptococcus

c) Streptococcus viridans 

d) Streptococcus pyogenes

The correct answer is A. Microaerophilic Streptococci.

Chronic burrowing type of ulcer is due to symbiotic action of microaerophilic non-haemolytic streptococci and hemolytic Staphylococcus aureus. Clinically it is undermined ulcer with lot of granulation tissue in the floor. This condition is painful, toxaemic and the general condition of the patient deteriorates without treatment. Radical drainage is necessary for cure, antibiotics alone being useless.