22 - Systemic disease and the mouth Flashcards
What are the common reasons for dental manifestations of systemic disease in children?
- congenital conditions or infections
- illness or metabolic disorder
- pigmentation from substance in the blood
Give an example of a congenital condition or infection that has a dental manifestation.
- syphilis
- TORCH infection
- ectodermal dysplasia
What is a TORCH infection?
T - toxoplasmosis
O - other ie syphilis, Hep B
R - rubella
C - cytomegalovirus (CMV)
H - herpes simplex
Give an example of an illness or metabolic disorder that has a dental manifestation.
- severe childhood illness
- cancer treatment
Give an example of pigmentation from substances in the blood that have a dental manifestation.
- bilirubin (jaundice)
- tetracycline (antibiotics)
How does ectodermal dysplasia present orally?
- hypoplasia
- hypodontia
- can have affect on salivary glands
What are Hutchinson’s incisors?
- caused by syphilis infection
- permanent teeth are peg like
What presentation can perinatal illness have?
- calcification across teeth is affected
- seen at different stages of development
What is porphyria?
- rare metabolic disease that allows porphyrins to build up in the blood
- teeth are discoloured red/brown
How does high levels of bilirubin present orally?
- teeth are discoloured yellow/green
- must be significant jaundice for several years
How does tetracycline staining present?
- dark band across teeth if antibiotic is taken for a long period during tooth development
- these antibiotics are not recommended for children
How can systemic disease present with oral mucosal changes?
- giant cell granuloma
- oralfacial granulomatosis
- RAS
- dermatoses (lichen planus)
- immune deficiency
- drug reactions
What are giant cell granulomas?
- osteoclast related lesions that can be seen on radiograph
- can form due to irritation
- parathyroid function should be checked
What is the result of hyperparathyroidism?
- loss of cortical bone
- PTH is released in excess to raise serum calcium by activating osteoclasts
- can be seen in oral radiographs by the loss of lamina dura
How does Addison’s disease manifest orally?
- pigmentation of the mucosa
- caused by raised ACTH which stimulates melanocytes to cause reactive melanosis
What effects do haematinic deficiencies have orally?
- oral ulceration
- painful tongue
What is orofacial granulomatosis?
- peri-oral erythema and swelling
- associated with the ginger gene and dietary allergens
What is oral presentation of orofacial granulomatosis?
- perioral erythema
- lip swelling
- lip fissures
- angular cheilitis
- erythematous full thickness gingivitis (not plaque induced)
- stag horning
- linear ulceration along labial sulus (not related to trauma)
Define stag horning in OFG.
Oedema of FOM
What makes up a Crohn’s screening?
- altered bowel habits or abdominal pain
- growth monitoring
- faecal calprotectin
What allergens are associated with OFG?
- benzoates
- sorbate
- cinnamon
- chocolate
What is the management of OFG?
- 3 month diet exclusion
- topical treatment of of angular chelitis/fissure
- topical treatment of lip swelling or facial erythema
What is used for topical treatment of angular chelitis and lip fissures?
- miconazole cream
- hydrocortisone cream
What is used for topical treatment of lip swelling or facial erythema?
- tacrolimus ointment 0.03%
- intralesional steroids to lip
- systemic immune modulation
How does lupus present in the mouth?
Similar appearance to lichen planus
How does systemic sclerosis present in the mouth?
- loss of elasticity around mouth
- peri-oral stricture
- dental treatment requires long term planning due to lack of access
- low maintenance dentition required
What vasculitis diseases present in the mouth?
- giant cell arteritis
- polyarteritis nodosa
- Kawasaki disease
- Wegener’s granulomatosis
How does immune deficiency present in the mouth?
- opportunistic infections
- reactivation of HSV
- ulceration
What can cause haematinic deficiencies?
- poor dietary intake
- malabsorption (GI diseases eg coeliac)
- blood loss (Crohn’s, UC, cancer)
- increased demand (growth spurt)
What are the common oral effects of medical therapy?
- dry mouth
- oral ulceration
- lichenoid reaction
- angio-oedema
- osteonecrosis
What is angio-oedema?
- rapid swelling within an hour od perioral tissue
- complement cascade is affected by ACE inhibitor drug
- subsides within hours/day
