3- WBC values

purpose of WBC count in dentistry

1. WBC disorders can influence clinical decision since WBCs are the primary defense against infection

2. pts w/ life threatening WBC disorders should not receive dental tx w/o physician consult

2 categories of leukocytes (WBCs)

1. polymorphonucleocytes

2. mononucleocytes

what are the 2 types of polymorphonucleocytes

1. agranulocytes: monocytes

2. granulocytes: neutrophils, basophils, eosinophils

M N B E

what are the 2 types of mononucleocytes

1. agranulocytes: dendritic cells

2. granulocytes: mast cells, macrophages, NK cells

D M M N

normal range of circulating WBCs in adults

4400-110,000 μL

what’s ANC

absolute neutrophil count

normal range for ANC (absolute neutrophil count)

1500-7200 cells/mm³

ANC lower than 1500 mm³ indicates

increased risk for infection

ANC lower than 500 mm³ indicates

severe neutropenia → dental tx CANNOT be performed

how do you calculate ANC

WBC count x (neutrophil % + bands %)/100

• bands = % of immature neutrophils

leukemia vs. lymphoma

• leukemia: originates in bone marrow + spreads through blood

• lymphoma: originates in lymph nodes/spleen + spreads through lymphatic system

both affect lymphocytes

2 types of leukemia

1. myeloproliferative

2. lymphoproliferative

2 types of myeloproliferative disorders

1. acute myeloid leukemia: immature malignant myeloid cells

2. chronic myeloid leukemia: mature malignant myeloid cells

2 types of lymphoproliferative disorders

1. acute lymphoblastic leukemia: immature malignant lymphoid cells

2. chronic lymphoblastic leukemia: mature malignant lymphoid cells

2 types of lymphoma

1. Hodgkin’s: malignant B lymphocytes, primarily in lymph nodes

2. Non-Hodgkin’s: malignant B or T cells, many types/locations- mostly B cells

   1. Burkitt lymphoma: type of non-Hodgkin’s B cell lymphoma involving bone + lymph nodes

how does Hodgkin’s lymphoma first manifest in the body

• painless group of firm, nontender, enlarged lymph nodes

• usually located: mediastinal, neck, underarm, groin nodes

symptoms of Hodgkin’s lymphoma

1. fever

2. fatigue

3. weight loss

4. night sweats

how does non-Hodgkin’s lymphoma first manifest in the body

multifocal enlarged painless lymph nodes

T/F: 20-40% of non-Hodgkin’s lymphoma pts develop enlargements outside of lymph nodes

true

symptoms of non-Hodgkin’s lymphoma

1. fever

2. weight loss

3. malaise

4. sweating

5. tender lymphadenopathy

6. abdominal/chest pain

what’s the most common lymphoma of childhood

Burkitt lymphoma

3 types of Burkitt lymphoma

1. endemic

2. sporadic

3. immunodeficiency associated

where do enlargements occur in Burkitt lymphoma

mostly at extra-nodal sites (outside of lymph nodes)

describe the tumor growth rate of Burkitt lymphoma

they can double in size every 3 days → airway, alimentary canal, vasculature obstruction

describe the location of enlargements in endemic Burkitt lymphoma

• usually in jaw, abdominal organs, kidneys, ovaries, adrenal glands

• jaw involvement is common in pts younger than 5

describe the oral manifestation of endemic Burkitt lymphoma

rapidly expanding tumor in posterior of maxilla/mandible w/ 50-70% of cases w/ jaw lesions → displacing adjacent teeth → resulting in mobile + abnormally positioned teeth

symptoms of oral manifestation of endemic Burkitt lymphoma

1. pain

2. paresthesia (tingling/numbness)

describe the radiograph of an endemic Burkitt lymphoma of the jaw

the tumor produces an osteolytic lesion w/ poorly demarcated margins, erosion of the cortical plate, + soft tissue involvement

what’s multiple myeloma

malignant plasma cells