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20 - Oral Manifestations of Systemic Diseases Flashcards

1
Q

What causes Jaundice?

A

It is caused bilirubinemia (Hyperbilirubenemia)

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2
Q

What does elevated bilirubin levels affect on the body?

A

It affects the skin, giving a yellow colour to the skin and mucosa.
It has an affinity for elastin fibers (sclera of the eyes, soft palate)

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3
Q

Who do we often see jaundice?

A
  • Patients with liver damage.
  • Newborns.
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4
Q

What are the causes of jaundice?

A

1.) Increased in RBC breakdown
2.) Increased in RBC production
3.) Decreased conjugation/excretion of bilirubin from the liver

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5
Q

What are the head and neck manifestations of jaundice?

A

1.) Yellow colour change to soft tissue
2.) Xerostomia
3.) Teeth staining in congenital jaundice
4.) Increased risk of candidiasis

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6
Q

What is cushing’s syndrome?

A

It is when an individual has a chronic elevation in glucocorticoid levels (hypercortisolism)

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7
Q

What occurs if the increase in cortisol occurs endogenously?

A

It will be termed Cushing’s disease.

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8
Q

How is cushing’s syndrome diagnosed?

A

Through urine and blood testing.

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9
Q

What can cause Cushing’s Syndrome?

A

1.) Elevated stress levels
2.) Alcoholism
3.) Depression
4.) Medications: common cause to increase in cortisol.
5.) Tumours: Pituitary gland & Adrenal gland

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10
Q

What are the signs and symptoms of Cushing’s Syndrome?

A

1.) Weight gain & fat accumulation:
- Buffalo hump
- moon facies

2.) Red abdominal striae
3.) Poor wound healing
4.) Emotional lability
5.) Hyperglycemia
6.) Thinning of skin
7.) Fatigue
8.) Anxiety

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11
Q

What are the head and neck manifestations of Cushing’s Syndrome?

A

1.) Increased prevalence of gingivitis and periodontal disease
2.) Xerostomia
3.) Poor wound healing
4.) Bruising

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12
Q

What is the treatment method to Cushing’s Syndrome?

A

Depending on the cause:
- Surgical removal of the tumour
- Discontinuation or alternative medication if medication induced

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13
Q

What is Addison’s Disease?

A

This is due to the hypoadrenocorticism, which is a decreased level of corticosteroid hormones.

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14
Q

What are the 2 types of Addison’s Disease?

A

1.) Primary hypoadrenocorticism
2.) Secondary hypoadrenocorticism

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15
Q

What does the primary hypoadrenocorticism of Addison’s Disease cause?

A

Destruction of the adrenal cortex

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16
Q

What does the secondary hypoadrenocorticism of Addison’s Disease cause?

A

Pituitary gland dysfunction

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17
Q

What are the causes of Addison’s Disease?

A

1.) Autoimmune destruction of adrenal cortex
2.) Infections
3.) Mestatic tumors
4.) Amyloidosis

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18
Q

What are the signs and symptoms of Addison’s Disease?

A

1.) Fatigue, irritability
2.) Hypotension
3.) Weakness
4.) Salt craving
5.) Generalized skin hyperpigmentation (Skin bronzing): most noticeable on sun-exposed skin.

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19
Q

What are some head & neck manifestations of Addison’s Disease?

A

1.) Increased pigmentation of facial skin
2.) Focal deposits of melanin on oral mucosa: Buccal and labial mucosa is most common
3.) Xerostomia

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20
Q

How is Addison’s Disease treated?

A

1.) Replacement of missing cortisol
2.) Replacement of missing aldosterone

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21
Q

What is the prognosis of Addison’s Disease?

A

Provides a good overall prognosis
Must beware of patients with infections, pregnancy, stress (complex medical procedures) as medications may need to be altered

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22
Q

What is type 1 diabetes involved with?

A

with the lack of insulin due to the breakdown of pancreatic islet cells. This won’t produce enough insulin.

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23
Q

What is type 2 diabetes involved with?

A

with the insulin being less effective. This is due to obesity, inactivity, and genetics.

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24
Q

What are the signs and symptoms of diabetes mellitus?

A

1.) Frequent urination
2.) Elevated thirst
3.) Xerostomia
4.) Poor wound healing

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25
Q

What are the microvascular complications of diabetes mellitus?

A

1.) Retinopathy: damage to the blood vessel
2.) Renal failure: blood vessels feeding to kidneys get damaged
3.) Neuropathy: Peripheral that feed to our hand.

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26
Q

What are the macrovascular complications of diabetes mellitus?

A

1.) Stroke
2.) Heart disease and hypertension
3.) Peripheral vascular disease

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27
Q

What are the oral manifestations of diabetes mellitus?

A

1.) Xerostomia
2.) Burning tongue syndrome
3.) Poor healing
4.) Gingivitis/periodontal disease
5.) Increase in infections
6.) Diabetic sialedenosis

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28
Q

What are the treatments for diabetes?

A

1.) Type 1: Management with insulin injections
2.) Type 2: Exercise, dietary changes
3.) Variety of medications

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29
Q

What is the prognosis of diabetes mellitus?

A

1.) Fair to good
2.) Depends on the level of control
3.) Regular monitoring is required

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30
Q

What is uremic stomatitis?

A

1.) It is due to the elevated uremic acid levels seen in kidney failure.

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31
Q

In which patients is this more prevalent in?

A

Patients who require dialysis for kidney failure

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32
Q

What are some oral manifestations of uremic stomatitis?

A

1.) Pseudomembranous formation
2.) Halitosis: smells like ammonia or urine
3.) Ulceration
4.) Hemorrhage

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33
Q

What are the treatments needed for uremic stomatitis?

A

1.) Acidic mouth rinse for oral symptoms
2.) Anesthetic rinses
3.) Must address kidney issues (dialysis or transplant)

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34
Q

What is the prognosis of uremic stomatitis?

A

Improves rapidly after dialysis or transplant.

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35
Q

What are the 2 major forms of inflammatory bowel disease?

A

1.) Crohn’s disease
2.) Ulcerative colitis

36
Q

What occurs in Crohn’s disease?

A

1.)Regional ileitis (inflammation of the ileum)
2.) It is known as an immune-mediated, inflammatory condition affecting any part of the gastrointestinal system.
3.) Extra intestinal involvement is seen in: skin, eyes, joints.
4.) Oral lesions can often represent the earliest manifestation of the disease

37
Q

What are the signs and symptoms of inflammatory bowel disease?

A

1.) Abdominal pain and cramping

2.) Weight loss

3.) Malnutrition:
- leading to anemia (low RBCS)
- Decreased growth

4.) Nausea/diarrhea

38
Q

What are the oral manifestations of inflammatory bowel disease?

A

1.) Nodular swelling of the labial and vestibular mucosa
2.) Cobblestoning of the buccal mucosa
3.) Linear ulcerations in the vestibule
4.) Orofacial granulomatosis (swelling of the mouth & lips)
5.) Ulcerations
6.) Infrequently - pyostomatitis vegetans

39
Q

What is pyostomatitis vegetans?

A

1.) They are the rare expression of inflammatory bowel diseases
2.) They have yellowish/white “snail track” lesions involving the oral mucosa
3.) Often concurrent with GI symptoms

40
Q

What are the treatments needed for Inflammatory Bowel Disease?

A

1.) Immunomodulatory medications
2.) Surgery
3.) Oral lesions tend to resolve when the generalized condition is managed.

41
Q

What is Scurvy?

A

It is a deficiency of Vitamin C known as Hypovitaminosis.

42
Q

What are the signs and symptoms of scurvy?

A

1.) Malaise, anemia, pallor
2.) Weakened vascular walls
3.) Ulcer formation
4.) Hemorrhage of the gingiva
5.) Gingival hyperplasia
6.) Fever
7.) Death

43
Q

What are some oral manifestations of scurvy?

A

1.) Gingival hyperplasia
2.) Spontaneous gingival hemorrhage
3.) Loose teeth
4.) Premature exfoliation of teeth
5.) Tongue enlargement is possible

44
Q

How is scurvy treated?

A

With an increase intake of Vitamin C.

45
Q

What is Vitamin D?

A

A fat-soluble steroid hormone which is obtained from sunlight exposure and diet

46
Q

What can a deficiency of Vitamin D cause?

A

In children, it will cause rickets (imperfect bones or distortion in the bones)
In adults, it will cause osteomalacia (softening of the bones)

47
Q

What are the signs and symptoms of Vitamin D deficiency?

A

1.) Poor bone formation
2.) Bowed legs
3.) Delayed growth
4.) Osteoporosis in adults
5.) Diffuse bone pain
6.) Elevated risk of bone fracture
7.) Cardiovascular concerns

48
Q

What are the head and neck manifestations of Vitamin D Deficiency?

A

1.) Enamel hypoplasia (low development of the enamel matrix)
2.) Enamel hypo calcification (not being calcified)
3.) Frontal bossing (enlargement of head)

49
Q

What is hypoparathyroidism?

A

It is a decrease in parathyroid hormone levels (PTH)

50
Q

How is PTH produced?

A

By the parathyroid glands.

51
Q

What is the role of PTH?

A

1.) To regulate calcium
2.) Works with Vitamin D
3.) Leads to increased calcium resorption in the kidneys
4.) Increased calcium removal from the bone via osteoclasts

52
Q

What does a decrease in calcium lead to in the PTH levels?

A

The PTH levels will increase to restore the calcium levels.

53
Q

What are the causes of decreased PTH levels?

A

1.) Surgical removal of the parathyroid glands
2.) Autoimmune destruction of parathyroid glands

54
Q

What are the signs and symptoms of hypoparathyroidism?

A

1.) Tetany in feet and hands (trousseu’s sign & chvostek’s sign)
2.) Tingling and numbness
3.) Muscle weakness
4.) Cramps
5.) Seizures
6.) Arrythmia

55
Q

What are the head and neck manifestations of hypoparathyroidism?

A
  • Chvostek’s sign: twitching of upper lip when facial nerve is tapped
  • Tingling and numbness of the mouth
  • Pediatric onset:
    1.) Enamel pitting
    2.) Failure of tooth eruption.
56
Q

What is hypophosphatasia?

A

It is an inherited metabolic disease from AD or AR inheritance.

57
Q

What are the main varieties of hypophosphatasia?

A

That the more younger the onset, the more severe the disease.

58
Q

What are the lab findings of hypophosphatasia?

A

That they have decreased alkaline phosophatase levels & Have increased phosphoethanolamine levels.

59
Q

What are the signs and symptoms of hypophosphatasia?

A

1.) Failure to grow
2.) Bone abnormalities resembling rickets
3.) Short stature
4.) Bowing of the legs

60
Q

What are the head & neck manifestations of hypophosphatasia?

A

1.) Premature loss of primary teeth
2.) Enlarged pulps
3.) Enamel hypoplasia
4.) “Beaten copper” skull - unique to hypophosphatasia

61
Q

What is gigantism?

A

It is a rare condition that causes an increased production of growth hormone before epiphyseal plates fuse together.

62
Q

What are the causes of gigantism?

A

1.) Pituitary adenoma (most common)
2.) Association with polyostotic fibrous dysplasia + cafe au lait pigmentation + endocrine disorders)

63
Q

What are the signs and symptoms of gigantism?

A

1.) Rapid growth (very tall)
2.) Enlargement of hands and feet
3.) Reduced life span
4.) Hypertension, osteoporosis

64
Q

What are the oral manifestations of gigantism?

A

1.) enlargement of soft tissue (tongue enlargement)
2.) Enlargement of the mandible
3.) Macrodontia

65
Q

What is acromegaly?

A

It is the excess growth hormone AFTER the closure of the epiphyseal plates

66
Q

What is the most common cause of acromegaly?

A

1.) The pituitary adenoma

67
Q

What are the lab tests results say about Acromegaly?

A

That there is an elevated serum of growth hormones (GH) levels

68
Q

What are the signs and symptoms of acromegaly?

A

1.) Hypertension
2.) Cardiac disease
3.) Osteoarthritis
4.) Peripheral neuropathy
5.) Growth of the mandible, hands, and feet.

69
Q

What are the head and neck manifestations of acromegaly?

A

1.) Mandibular prognathism (enlarged mandible)
2.) Macroglossia
3.) Coarse facial appearance
4.) Soft tissue enlargement: Predilection towards sleep apnea due to soft palate enlargement

70
Q

What are the treatment methods of acromegaly?

A

1.) Removal of tumor
2.) Radiation
3.) Growth hormone inhibitors

71
Q

What is hypothyroidism?

A

It is a common condition where a decreased level of thyroid hormone is seen.

72
Q

What is the term hypothyroidism known as in children?

A

Cretinism

73
Q

What is the term hypothyroidism known as in adults?

A

Myxedema

74
Q

What are the 2 varieties of Hypothyroidism?

A

1.) Primary hypothyroidism: abnormal thyroid gland
2.) Secondary hypothyroidism: abnormality in pituitary gland

75
Q

What are the lab values of hypothyroidism?

A
  • Decrease the thyroxine levels
  • Primary hypothyroidism: increased TSH levels
  • Secondary hypothyroidism: decreased TSH levels
76
Q

What are the signs and symptoms of hypothyroidism?

A

1.) Lethargy and fatigue
2.) Coarse, dry hair
3.) Goiter
4.) Constipation
5.) Weakness
6.) Bradycardia
7.) Hypothermia

77
Q

What are the head and neck manifestations of hypothyroidism?

A

1.) Swelling of the face
2.) Macroglossia
3.) Enlargement of the lips
4.) Mouth breathing
5.) Teeth failing to erupt

78
Q

What are the treatments for hypothyroidism?

A

The replacement of thyroid hormones

79
Q

What is the prognosis of hypothyroidism?

A

1.) Good prognosis if caught early
2.) Poor prognosis if there is a delay in diagnosis

80
Q

Causes hyperthyroidism?

A

it is due to elevated levels of thyroid hormones, which is much more common in females than males.

81
Q

What are the causes of hyperthyroidism?

A

1.) Grave’s disease
2.) Hyperplastic thyroid tissue
3.) Thyroid tumour
4.) Pituitary adenoma

82
Q

What are the signs and symptoms hyperthyroidism?

A

1.) Weight loss
2.) Goiter
3.) Tachycardia
4.) Perspiration
5.) Warm, smooth skin
6.) Exophthalmos: bulging of the eyes

83
Q

What are the oral manifestations of hyperthyroidism?

A

1.) Premature loss of primary teeth
2.) Enlargement of thyroid tissue
3.) Maxillary and mandibular osteoporosis
4.) Increase in burning mouth syndrome

84
Q

What are the treatments of hyperthyroidism?

A

1.) Surgical removal of thyroid gland
2.) Drug therapy

85
Q

What is the prognosis of hyperthyroidism?

A
  • Overall good prognosis
  • Risk of “thyroid storm” if uncontrolled.

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