20 - Oral Manifestations of Systemic Diseases Flashcards
What causes Jaundice?
It is caused bilirubinemia (Hyperbilirubenemia)
What does elevated bilirubin levels affect on the body?
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)
Who do we often see jaundice?
- Patients with liver damage.
- Newborns.
What are the causes of jaundice?
1.) Increased in RBC breakdown
2.) Increased in RBC production
3.) Decreased conjugation/excretion of bilirubin from the liver
What are the head and neck manifestations of jaundice?
1.) Yellow colour change to soft tissue
2.) Xerostomia
3.) Teeth staining in congenital jaundice
4.) Increased risk of candidiasis
What is cushing’s syndrome?
It is when an individual has a chronic elevation in glucocorticoid levels (hypercortisolism)
What occurs if the increase in cortisol occurs endogenously?
It will be termed Cushing’s disease.
How is cushing’s syndrome diagnosed?
Through urine and blood testing.
What can cause Cushing’s Syndrome?
1.) Elevated stress levels
2.) Alcoholism
3.) Depression
4.) Medications: common cause to increase in cortisol.
5.) Tumours: Pituitary gland & Adrenal gland
What are the signs and symptoms of Cushing’s Syndrome?
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
What are the head and neck manifestations of Cushing’s Syndrome?
1.) Increased prevalence of gingivitis and periodontal disease
2.) Xerostomia
3.) Poor wound healing
4.) Bruising
What is the treatment method to Cushing’s Syndrome?
Depending on the cause:
- Surgical removal of the tumour
- Discontinuation or alternative medication if medication induced
What is Addison’s Disease?
This is due to the hypoadrenocorticism, which is a decreased level of corticosteroid hormones.
What are the 2 types of Addison’s Disease?
1.) Primary hypoadrenocorticism
2.) Secondary hypoadrenocorticism
What does the primary hypoadrenocorticism of Addison’s Disease cause?
Destruction of the adrenal cortex
What does the secondary hypoadrenocorticism of Addison’s Disease cause?
Pituitary gland dysfunction
What are the causes of Addison’s Disease?
1.) Autoimmune destruction of adrenal cortex
2.) Infections
3.) Mestatic tumors
4.) Amyloidosis
What are the signs and symptoms of Addison’s Disease?
1.) Fatigue, irritability
2.) Hypotension
3.) Weakness
4.) Salt craving
5.) Generalized skin hyperpigmentation (Skin bronzing): most noticeable on sun-exposed skin.
What are some head & neck manifestations of Addison’s Disease?
1.) Increased pigmentation of facial skin
2.) Focal deposits of melanin on oral mucosa: Buccal and labial mucosa is most common
3.) Xerostomia
How is Addison’s Disease treated?
1.) Replacement of missing cortisol
2.) Replacement of missing aldosterone
What is the prognosis of Addison’s Disease?
Provides a good overall prognosis
Must beware of patients with infections, pregnancy, stress (complex medical procedures) as medications may need to be altered
What is type 1 diabetes involved with?
with the lack of insulin due to the breakdown of pancreatic islet cells. This won’t produce enough insulin.
What is type 2 diabetes involved with?
with the insulin being less effective. This is due to obesity, inactivity, and genetics.
What are the signs and symptoms of diabetes mellitus?
1.) Frequent urination
2.) Elevated thirst
3.) Xerostomia
4.) Poor wound healing
What are the microvascular complications of diabetes mellitus?
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.
What are the macrovascular complications of diabetes mellitus?
1.) Stroke
2.) Heart disease and hypertension
3.) Peripheral vascular disease
What are the oral manifestations of diabetes mellitus?
1.) Xerostomia
2.) Burning tongue syndrome
3.) Poor healing
4.) Gingivitis/periodontal disease
5.) Increase in infections
6.) Diabetic sialedenosis
What are the treatments for diabetes?
1.) Type 1: Management with insulin injections
2.) Type 2: Exercise, dietary changes
3.) Variety of medications
What is the prognosis of diabetes mellitus?
1.) Fair to good
2.) Depends on the level of control
3.) Regular monitoring is required
What is uremic stomatitis?
1.) It is due to the elevated uremic acid levels seen in kidney failure.
In which patients is this more prevalent in?
Patients who require dialysis for kidney failure
What are some oral manifestations of uremic stomatitis?
1.) Pseudomembranous formation
2.) Halitosis: smells like ammonia or urine
3.) Ulceration
4.) Hemorrhage
What are the treatments needed for uremic stomatitis?
1.) Acidic mouth rinse for oral symptoms
2.) Anesthetic rinses
3.) Must address kidney issues (dialysis or transplant)
What is the prognosis of uremic stomatitis?
Improves rapidly after dialysis or transplant.
What are the 2 major forms of inflammatory bowel disease?
1.) Crohn’s disease
2.) Ulcerative colitis
What occurs in Crohn’s disease?
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
What are the signs and symptoms of inflammatory bowel disease?
1.) Abdominal pain and cramping
2.) Weight loss
3.) Malnutrition:
- leading to anemia (low RBCS)
- Decreased growth
4.) Nausea/diarrhea
What are the oral manifestations of inflammatory bowel disease?
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
What is pyostomatitis vegetans?
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
What are the treatments needed for Inflammatory Bowel Disease?
1.) Immunomodulatory medications
2.) Surgery
3.) Oral lesions tend to resolve when the generalized condition is managed.
What is Scurvy?
It is a deficiency of Vitamin C known as Hypovitaminosis.
What are the signs and symptoms of scurvy?
1.) Malaise, anemia, pallor
2.) Weakened vascular walls
3.) Ulcer formation
4.) Hemorrhage of the gingiva
5.) Gingival hyperplasia
6.) Fever
7.) Death
What are some oral manifestations of scurvy?
1.) Gingival hyperplasia
2.) Spontaneous gingival hemorrhage
3.) Loose teeth
4.) Premature exfoliation of teeth
5.) Tongue enlargement is possible
How is scurvy treated?
With an increase intake of Vitamin C.
What is Vitamin D?
A fat-soluble steroid hormone which is obtained from sunlight exposure and diet
What can a deficiency of Vitamin D cause?
In children, it will cause rickets (imperfect bones or distortion in the bones)
In adults, it will cause osteomalacia (softening of the bones)
What are the signs and symptoms of Vitamin D deficiency?
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
What are the head and neck manifestations of Vitamin D Deficiency?
1.) Enamel hypoplasia (low development of the enamel matrix)
2.) Enamel hypo calcification (not being calcified)
3.) Frontal bossing (enlargement of head)
What is hypoparathyroidism?
It is a decrease in parathyroid hormone levels (PTH)
How is PTH produced?
By the parathyroid glands.
What is the role of PTH?
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
What does a decrease in calcium lead to in the PTH levels?
The PTH levels will increase to restore the calcium levels.
What are the causes of decreased PTH levels?
1.) Surgical removal of the parathyroid glands
2.) Autoimmune destruction of parathyroid glands
What are the signs and symptoms of hypoparathyroidism?
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
What are the head and neck manifestations of hypoparathyroidism?
- 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.
What is hypophosphatasia?
It is an inherited metabolic disease from AD or AR inheritance.
What are the main varieties of hypophosphatasia?
That the more younger the onset, the more severe the disease.
What are the lab findings of hypophosphatasia?
That they have decreased alkaline phosophatase levels & Have increased phosphoethanolamine levels.
What are the signs and symptoms of hypophosphatasia?
1.) Failure to grow
2.) Bone abnormalities resembling rickets
3.) Short stature
4.) Bowing of the legs
What are the head & neck manifestations of hypophosphatasia?
1.) Premature loss of primary teeth
2.) Enlarged pulps
3.) Enamel hypoplasia
4.) “Beaten copper” skull - unique to hypophosphatasia
What is gigantism?
It is a rare condition that causes an increased production of growth hormone before epiphyseal plates fuse together.
What are the causes of gigantism?
1.) Pituitary adenoma (most common)
2.) Association with polyostotic fibrous dysplasia + cafe au lait pigmentation + endocrine disorders)
What are the signs and symptoms of gigantism?
1.) Rapid growth (very tall)
2.) Enlargement of hands and feet
3.) Reduced life span
4.) Hypertension, osteoporosis
What are the oral manifestations of gigantism?
1.) enlargement of soft tissue (tongue enlargement)
2.) Enlargement of the mandible
3.) Macrodontia
What is acromegaly?
It is the excess growth hormone AFTER the closure of the epiphyseal plates
What is the most common cause of acromegaly?
1.) The pituitary adenoma
What are the lab tests results say about Acromegaly?
That there is an elevated serum of growth hormones (GH) levels
What are the signs and symptoms of acromegaly?
1.) Hypertension
2.) Cardiac disease
3.) Osteoarthritis
4.) Peripheral neuropathy
5.) Growth of the mandible, hands, and feet.
What are the head and neck manifestations of acromegaly?
1.) Mandibular prognathism (enlarged mandible)
2.) Macroglossia
3.) Coarse facial appearance
4.) Soft tissue enlargement: Predilection towards sleep apnea due to soft palate enlargement
What are the treatment methods of acromegaly?
1.) Removal of tumor
2.) Radiation
3.) Growth hormone inhibitors
What is hypothyroidism?
It is a common condition where a decreased level of thyroid hormone is seen.
What is the term hypothyroidism known as in children?
Cretinism
What is the term hypothyroidism known as in adults?
Myxedema
What are the 2 varieties of Hypothyroidism?
1.) Primary hypothyroidism: abnormal thyroid gland
2.) Secondary hypothyroidism: abnormality in pituitary gland
What are the lab values of hypothyroidism?
- Decrease the thyroxine levels
- Primary hypothyroidism: increased TSH levels
- Secondary hypothyroidism: decreased TSH levels
What are the signs and symptoms of hypothyroidism?
1.) Lethargy and fatigue
2.) Coarse, dry hair
3.) Goiter
4.) Constipation
5.) Weakness
6.) Bradycardia
7.) Hypothermia
What are the head and neck manifestations of hypothyroidism?
1.) Swelling of the face
2.) Macroglossia
3.) Enlargement of the lips
4.) Mouth breathing
5.) Teeth failing to erupt
What are the treatments for hypothyroidism?
The replacement of thyroid hormones
What is the prognosis of hypothyroidism?
1.) Good prognosis if caught early
2.) Poor prognosis if there is a delay in diagnosis
Causes hyperthyroidism?
it is due to elevated levels of thyroid hormones, which is much more common in females than males.
What are the causes of hyperthyroidism?
1.) Grave’s disease
2.) Hyperplastic thyroid tissue
3.) Thyroid tumour
4.) Pituitary adenoma
What are the signs and symptoms hyperthyroidism?
1.) Weight loss
2.) Goiter
3.) Tachycardia
4.) Perspiration
5.) Warm, smooth skin
6.) Exophthalmos: bulging of the eyes
What are the oral manifestations of hyperthyroidism?
1.) Premature loss of primary teeth
2.) Enlargement of thyroid tissue
3.) Maxillary and mandibular osteoporosis
4.) Increase in burning mouth syndrome
What are the treatments of hyperthyroidism?
1.) Surgical removal of thyroid gland
2.) Drug therapy
What is the prognosis of hyperthyroidism?
- Overall good prognosis
- Risk of “thyroid storm” if uncontrolled.
