# Oral Haematology > Oral haematology for NEET-MDS Oral Medicine: glossitis and angular cheilitis, Plummer-Vinson, sickle trabeculae, leukaemic gingivae and surgical thresholds. - Canonical URL: https://prepelephant.com/topics/neet-mds/oral-medicine-and-radiology/oral-haematology-mds - Exam / course: NEET-MDS · Subject: Oral Medicine and Radiology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Oral Haematology", PrepElephant, https://prepelephant.com/topics/neet-mds/oral-medicine-and-radiology/oral-haematology-mds ## Direct answer Anaemia and blood dyscrasias announce themselves in the mouth before the blood report arrives: the pale, sore, smooth tongue of iron deficiency or megaloblastic anaemia, the angular cheilitis that will not heal, the aphthae that recur too often, and — at the far end of danger — the swollen, bleeding gums and petechiae of acute leukaemia. The oral physician's role is recognising the haematological pattern behind common mucosal signs, requesting the targeted screen (haemoglobin, indices, iron studies, B12 and folate, and a film when the count looks wrong), and knowing the surgical thresholds: platelet counts, absolute neutrophil counts and INR values that decide whether dental treatment proceeds, waits, or happens in hospital. ## What you must remember - Iron deficiency presents orally with pallor of the mucosa, atrophic glossitis, angular cheilitis, candidosis and recurrent aphthae; Plummer-Vinson (Paterson-Brown-Kelly) syndrome adds dysphagia, oesophageal webs and koilonychia — and carries a risk of upper alimentary squamous carcinoma. - Megaloblastic anaemia (B12, folate; pernicious anaemia as the autoimmune B12 prototype) produces a beefy-red, sore, smooth tongue with angular cheilitis; B12 deficiency adds paraesthesia and neuropsychiatric features. - Sickle cell anaemia shows the classic mandibular radiographic pattern — enlarged marrow spaces with a stepladder trabecular arrangement (the skull showing hair-on-end striations); dental care avoids hypoxia, dehydration and infection that provoke crises. - Thalassaemia major deforms the maxilla through extramedullary haematopoiesis — the "chipmunk facies", maxillary protrusion, crowding and malocclusion — and transfusional iron overload discolours tissues. - Acute leukaemia, especially monocytic subtypes (AML M4 and M5): gingival enlargement that is haemorrhagic and out of proportion to plaque, spontaneous gingival bleeding, mucosal petechiae and ecchymoses, necrotic ulcers, and firm cervical lymphadenopathy — with the full blood count as the urgent first test. - Cyclic neutropenia produces recurrent oral ulceration with fever in roughly three-week cycles, resolving as the count recovers; the periodicity is the diagnostic clue. - Surgical thresholds commonly quoted for dental extraction: platelets above about 50 x 10^9 per litre; deferral or haematology liaison when the absolute neutrophil count falls below about 1.5 x 10^9 per litre; INR up to about 3.5 acceptable for routine extraction with local haemostatic measures per local protocol. - Multiple myeloma: punched-out radiolucencies of the skull, jaw pain and pathological fracture, anaemia — and amyloid deposition causing macroglossia in a minority. ## Reading the mouth as a blood film A 60-year-old woman attends for a sore tongue of four months; the tongue is smooth, atrophic and beefy-red, angular cheilitis cracks both mouth corners, and she admits fatigue and breathlessness on stairs. Before prescribing an antifungal and hoping, request the anaemia screen: haemoglobin, mean corpuscular volume, ferritin, B12 and folate. A microcytic picture with low ferritin leads to iron studies and gastrointestinal investigation — and if dysphagia coexists, to evaluation for Plummer-Vinson webs; a macrocytic picture leads to B12 assessment with intrinsic factor antibodies for pernicious anaemia. The glossitis and cheilitis resolve with repletion, but the underlying cause, not the tongue, is the referral. Contrast the emergency at the other end: a 28-year-old with two weeks of swollen, bleeding gingivae disproportionate to plaque, palatal petechiae and cervical nodes — this mouth is not a periodontal problem, it is a full blood count today, and the film showing blasts means immediate haematology referral before any dental instrumentation. ## Where students slip The recurring failure is topical thinking: treating angular cheilitis and glossitis as local infections month after month without a haemoglobin study — the antifungal that partially works while the deficiency marches on. The second is misreading leukaemic gingivitis as plaque-induced: disproportionate swelling, spontaneous bleeding and systemic signs in a young adult demand a blood count before scaling. The third is threshold arithmetic in safe dental surgery — candidates who cannot state approximate platelet, neutrophil and INR values cannot answer the practical question every clinic eventually faces. Finally, name the radiographic patterns precisely — stepladder trabeculae for sickle cell, punched-out lesions for myeloma — because image-based questions reward exact phrases, not impressions. ## Frequently asked questions ### What oral changes accompany iron deficiency? Mucosal pallor, atrophic glossitis, angular cheilitis, candidosis and recurrent aphthae — with Plummer-Vinson adding dysphagia, webs and koilonychia. ### How does leukaemia present orally? Gingival enlargement (classically monocytic AML), spontaneous bleeding and petechiae, necrotic ulcers and firm nodes — prompting an urgent blood count. ### What is the mandibular pattern of sickle cell anaemia? Enlarged medullary spaces with coarse vertical stepladder trabeculae from marrow hyperplasia; the skull shows hair-on-end striations. ### Which thresholds guide dental extraction in blood disorders? Commonly: platelets above about 50 x 10^9/L, neutrophils above about 1.5 x 10^9/L, INR to about 3.5 with local haemostasis — per local protocol. ### What is cyclic neutropenia? Neutrophil falls roughly every three weeks producing recurrent ulcers, fever and gingivitis that recover between cycles. ### Why does thalassaemia major deform the jaws? Extramedullary haematopoiesis expands the maxillary marrow, producing protrusion and crowding — the chipmunk facies.