Langerhans Cell Histiocytosis the Great Mimicker, Awareness in Oral Diagnosis and Management

Abstract

Aim: Langerhans cell histiocytosis or LCH is an atypical cancer originating form histocytes. Dental manifestation may mimic aggressive form of periodontitis with gingival overgrowth and bleeding, advance   alveolar bone loss as well as generalized mobility of tooth. The ambiguity of its clinical features is one of the factors that makes identifying the disease a difficult task. Presentation of Case: A 30 years old Malay man came with complain of gingival swelling and bleeding on the upper right quadrant associated with bad breath, scarce saliva, generalized tooth mobility, and whitish slough on the gingiva. The condition however does not present with pain or any systemic condition. The patient claimed to be systemically healthy. Intraoral examination displayed a diffused, erythematous swelling over attached gingiva on the maxillary posterior buccal region bilaterally along with sign of loss of pyramidal shape and ulceration with a punched-out profile covered by necrotic slough. Discussion: Diagnosis of LCH is done with the aid of immunohisto chemical analysis of CD1a and S100. The clinical course of LCH is highly unpredictable and irregular, improvement noticeable with conventional periodontal treatments in controlling the oral manifestations of LCH on early course of the disease.  Conclusion: Proper multidisciplinary approach is essential in the management for the benefit of the patient in such rare entity.