in the field of dentistry , gingival hypertrophy ( gh ) is a common presenting complaint , especially among patients belonging to pediatric age group .
gingivitis is a commonly occurring phenomenon since the oral cavity is a potential site for active infection as it is constantly exposed to pathogenic microorganisms .
the prevalence of gh among school going children is nearly 14% , inflammatory origin being the most common cause followed by chronic drug intake .
hence , there is a tendency among us to consider gh as a mere inflammatory response to local infection rather than considering systemic illnesses ; this can eventually lead to delay in diagnosis and initiating appropriate treatment .
gh due to acute myeloid leukemia ( aml ) in a child is extremely rare . here
, we report a case of aml ( subtype m5 of fab classification ) in a 3-year - old male child wherein the disease primarily presented as gh .
a 3-year - old male child presented to us with fever and body pain for 2 weeks , gum swelling for 1-month duration , initially presented to a pediatrician and a dentist , for which symptomatic treatment was given . the child was again reviewed with the pediatrician after 1 week with persisting symptoms .
no history of halitosis or dental caries . on general examination , he had pallor ; there was no icterus , cyanosis , clubbing , pedal edema , or generalized lymphadenopathy .
oral examination revealed the enlargement of maxillary and mandibular gingiva covering two - third of the crown structure in buccal , lingual , and palatal aspects .
gingiva was reddish with the loss of stippling , soft , spongy , bleeding on touch but was nontender and not warm [ figure 1 ] . on abdominal examination , the liver was palpable 2.5 cm below the right costal margin , and the spleen was palpable 2 cm beyond the left costal margin .
g / l , total white blood cell count was 5.6  10/l with 90% blast cells and 10% lymphocytes , and platelet count was 0.9  10/l .
his renal and liver function tests were within the normal range ; uric acid and lactate dehydrogenase levels were also normal .
bone marrow aspirate smear showed blasts which are large with moderate amount of agranular to granular cytoplasm and round to irregular nucleus with fine chromatin and 13 nucleoli .
few of the blasts showed auer rods [ figure 2 ] . in flow cytometric analysis , the blasts were positive for cd33 , cd117 , human leukocyte antigen - dr , and cd13 .
parents were counseled about his condition , treatment , and outcome of the disease . due to long distance commuting issues ,
the parents opted for the child to receive treatment elsewhere ; the child was lost to follow - up .
most common causes of gh in children are poor dental hygiene and chronic drug intakes such as phenytoin , cyclosporine , and calcium channel blockers . systemic illnesses such as wegener 's granulomatosis , sarcoidosis , crohn 's disease , infantile systemic hyalinosis , tuberculosis , and hereditary gingival hyperplasia should also be considered in the differential diagnosis .
acute leukemia , which is the most common malignant disorder in children , is characterized by neoplastic proliferation of blast cells causing accumulation of > 20% blast cells in the bone marrow , interfering hematopoiesis resulting in fatigability , bleeding tendency , and infections .
acute leukemia is subdivided into acute lymphoblastic leukemia and acute myeloid leukemia ( aml ) , based on the phenotype of the blast .
aml in a child generally presents with fatigue , pallor , abnormal bleeding and infections with or without splenomegaly and lymphadenopathy ; however rarely , it can present with infiltration of blasts cells in tissues such as skin , mucosa , and gums .
literature review has shown only few studies that have reported cases of aml presenting with oral lesion as a primary manifestation .
oral manifestations in leukemia are gh , oral ulcers , pale mucosa , herpes , and candida infections .
gingival infiltration in aml is rare , usually associated with subtypes m4 and m5 ( fab classification ) .
it is due to infiltration of tissues with neoplastic precursors of myeloid cells or secondary to thrombocytopenia , neutropenia , or impaired granulocyte function .
hence , gingival tissue , although unusual , is one of the sites that should be monitored for relapse .
although confirmatory diagnosis and treatment of aml is primarily done by the pediatric hemato - oncologist , it is almost always a dentist or a pediatrician who first attend to cases of gh , and hence increasing awareness among them will aid in early detection and prompt referral and drastically improve the outcome of the disease .
finally , any gh , particularly when associated with hepatosplenomegaly and abnormal blood counts should raise the suspicion of possible underlying hematological malignancy in the child .
 acute leukemia is the most common malignant disorder of childhood . 
 acute leukemia is characterized by marrow failure due to the replacement of marrow elements by leukemic blasts . 
 gingival hypertrophy ( gh ) due to acute myeloid leukemia ( aml ) in a child is extremely rare . here 
 , we report a case of aml ( subtype m5 of fab classification ) in a 3-year - old male child wherein the disease primarily presented as gh . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION
Financial support and sponsorship
Conflicts of interest