The Supporting Tissues of the Tooth in Acute Secondary Agranulocytosis (Arsphenamin Neutropenia)1

Of all the lesions produced in the mucosa of the oral cavity and the pharynx by blood dyscrasias, the most marked and extended are those associated with socalled The gingiva, tonsils and peritonsillar areas bear most damage. These tissues often appear involved even before other signs of the disease become obvious. Since the disorder shows, among other features, a decrease rather than a total absence of polymorphonuclear cells the term acute has been suggested as more appropriate. While the oral manifestations in various types of leukemias were microscopically studied in the past, it was not until 1933 that the first microscopic examination of the gingiva and jaw lesions in a case of arsphenamin which came to autopsy was reported by the author. This early study dealt mainly with the description of the changes of the alveolar bone. This discussion attempts to answer the question why the agranulocytotic lesions appear mostly in the marginal gingivae before they proceed further. The cellular reaction in the gingiva and the changes in the jaw bones will be described also. More recent elaborate studies by Fitz-Hugh and Krumbhaar, Jackson and Parker, and especially, Custer emphasize the difference between agranulocytosis and agranulocytosis, which is the result of a particular hematologic sensitivity to certain drugs or microorganisms. Though the clinical symptoms of the 2 types are alike and include fever, chills, and necrotizing process in the mucosa of the mouth and throat without anemia or thrombocytopenia, Custer maintained that the bone marrow in neutropenia differs from that in agranulocytosis. Custer examined regenerating marrow and found that in the former forms in the neutrophil series predominate while the latter is characterized by the complete failure of proliferating myeloblasts to mature into granular neutrophils. Agreeing with Fitz-Hugh and Krumbhaar, Custer believed that the absence of an intrinsic factor prevents the maturation. The nature of this intrinsic factor is unknown. Custer's findings and conclusions were confirmed by the clear-cut study of Darling, Parker and Jackson. The clinical picture of the idiopathic and secondary neutropenia is supplemented by distinct findings in the bone marrow such as an increased number of myeloblasts, lymphocytes, plasma cells and marked formation of red blood cells.