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Blue line on the gum, abutting on the teeth
    Differential Diagnosis[Top] [Nav]
heavy metal toxicity (lead, bismuth, mercury, gold, silver, thallium, copper)
    Discussion -- not available online[Top] [Nav]
    Update Comments[Top] [Nav]
  • Libman, as in Libman-Sacks endocarditis, was a renowned diagnostician. This article is a collection of snippets, e.g. "In cases of suspected lead intoxication, it is necessary to examine the gums of every tooth, because a lead line need not be present in all of them. For careful diagnosis, one should use a magnifying glass which will make visible the separate pigmentary deposits in the tips of the papillae, and their location a little below the margin of the gums." [101]
  • Tartar deposits on the teeth accentuate formation of a bismuth line. [p. 184] [102]
  • The Burton lead line is blue because of the deposition of lead sulfide. Eating eggs may accentuate the line because of their sulfur content.
      Interestingly, there is an additional intersection between chickens and lead. In areas where lead mining was formerly done, "there are occasional cases of lead poisoning among animals such as horses and cows resulting from ingestion of contaminated grass roots. Other animals are even more at risk.... One way of pinpointing the ancient lead-workings is to ask if anyone in the area keeps chickens. On lead-rich ground it is impossible to do so as the birds' penchant for eating grit means they are soon poisoned." [103]
    Footnotes in Print Edition[Top] [Nav]
    (01) Classic Descriptions of Disease. 3rd ed.
  Major R. Springfield, IL: Thomas, 1945: 324-325.   Amazon.com
    (02) Differential Diagnosis of Oral Lesions. 3rd ed.
  Wood NK, Goaz PW. St. Louis: Mosby, 1985: 227-228.
    (03) Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery. 17th ed.
  Clain A. Bristol, UK: John Wright, 1986: 118.   Amazon.com
    (04) Difficult Diagnosis.
  Roberts HJ. Philadelphia: Saunders, 1958: 24(atlas).
    (05) Adult inorganic lead intoxication: presentation of 31 new cases and a review of recent advances in the literature.
  Cullen MR, Robins JM, et al.   Medicine (Baltimore) 1983 Jul;62(4):221-47.  Pubmed  Similars
    (06) Cecil Textbook of Medicine. 16th ed.
  Wyngaarden JB, Smith LH Jr, et al. Philadelphia: Saunders, 1982: 2225.   Amazon.com
    (07) Medical Diagnostic Signs: A Reference Collection of Eponymic Bedside Signs.
  Birrer RB, Birrer CD. Springfield, IL: Thomas, 1982: 21.   Amazon.com
    (08) DeGowin & DeGowin's Bedside Diagnostic Examination. 5th ed.
  DeGowin RL. NY: Macmillian, 1987: 147-148.   Amazon.com
    (09) Clinical Diagnostic Pearls.
  Birnholz JC, Michelson PE. Flushing, NY: Medical Examination, 1971: 27.
    (10) Discoloration of gum tissue adjacent to dental crowns.
  Fan FL.   JAMA. 1981;246:2245.
Lists 6 reasons why the discoloration may be present.
    New References[Top] [Nav]
    101.Notes on clinical observations and methods.
  Libman E.   J Mt Sinai Hosp. 1938-1939;5(4):197-203.
    102.Pigmentation of the skin.
  Jeghers H.   N Engl J Med. 1944;231:88-100,122-136,181-189.
    103.A Medical Tour through the Whole Island of Great Britain.
  Appleby L. London: Faber & Faber, 1994: 140.   Amazon.com
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    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:34 PDT on July 4, 2000.[Top]

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