Influence of Diet & Gastro-intestinal Disease on the Oral Mucosa Flashcards
What is the normal epithelial turn over for the buccal mucosa compared to skin?
25 days
Much faster than skin which is 50-70 days
In terms of blood levels what may you expect to see in patient with repeated vommiting?
Hypokalaemia (reduced potassium levels) observed in FBC
Haematinic deficiencies can lead to sensitivity of filiform papillae, what may a patient complain of orally as a result of this?
Soreness
Reduced taste sensation
Ulceration of the tongue
Candidiasis
What oropharyngeal conditions are associated with haematinic deficiencies?
- Glossitis
- Angular cheilitis + candidosis
- Recurrent oral ulceration
- Burning mouth
- Plummer-Vinson syndrome (web-like growth of membranes in the throat that makes swallowing difficult)
What may result in a patient with Protein energy malnutrition (PEM)?
What may you expect to see in the blood and saliva?
Impairment of both nonspecific and specific immunity
Increased blood + saliva levels of free corticosteroids
What is Bulimia Nervosa?
Repeated bouts of overeating where patient then purposely vommits or takes laxatives to counteract weight gain
What are some intra-oral features of zinc deficiencies?
- Hypogeusia (reduced taste)
- Angular cheilitis
- Superficial aphthous-like ulcers
- Candidal superinfection
- Delayed wound healing
Think zn=old people
What are some non-specific lesions of Crohn’s disease?
Non-specific as related to low haematinics
- Recurrent Oral Ulcers / RAS
- Angular cheilitis
- Glossitis
- Persistent submandibular lymphadenopathy
What are zinc dependant enzymes important for? (3)
Gene expression
Hormonal function
Cell mediated immunity
What are some specific lesions of Crohn’s disease?
(actually caused by Crohn’s)
- Indurated tag-like mucosal lesions
- “Cobblestone” mucosa
- Mucogingivitis
- Lip swelling
- Deep linear ulceration
What are some extra-oral features of zinc deficiencies?
- Bullous pemphigoid *
- Alopecia
- Diarrhoea
- Growth retardation
- Lethargy/depression
*rare skin condition that causes large, fluid-filled blisters
What are some oral features of coeliac disease?
Dental Hypoplasia *
Recurrent Oral Ulceration (ROU)
Glossitis
Burning Mouth
Angular Cheilitis
Lichen Planus
*enamel defects
What are oral features of bulimia nervosa?
- Sialodenosis (SG swelling)
- Dental erosion
- Ulcers on the soft palate
- Angular cheilitis (from haematinic deficiencies)
What are some oral features of alcoholism?
Sialadenosis (swollen parotid salivary glands)
Dental erosion (palatally, secondary to acid reflux)
Oral Squamous Cell Carcinoma
Signs of liver cirrhosis (e.g. easy bruising or jaundice)
What is glossitis?
What are the two types you may see what deficiences cause these?
Inflammation of the tongue
- Smooth depapillated (iron deficiency)
- Raw, beefy-red (vitamin B12 and folate deficiencies)
A patient has mild Iron, B12 or Folate deficiency. What may you expect to see orally?
Generalised oral epithelial atrophy & depapillation of dorsum of tongue
Atrophy = Tissue wastage
A patient presents with a smooth tongue what could be two possible causes of this?
Haematinic deficiencies (iron, B12, folate)
Candidiasis
Haematinic deficiences cause depapilation of the tongue
What is a Haematinic?
Nutrient required for the formation of blood cells
The main hematinics are iron, B12, and folate
The process of hematopoiesis
A patient has vitmamin C deficiency what may you initially see extra-orally and later see intra-orally?
Initially
Enlargement & keratosis of hair follicles (Cork-screw hairs)
Later (weeks)
Blood vessel proliferation around hair follicles & interdental papillae
Which leads to Gingival hyperplasia & haemorrhage
What are some extra-oral clinical features of Coeliac Disease?
- Malabsorption - Fatigue & Anaemia
- Chronic diarrhoea
- Weight loss
- Abdominal distension (swollen abdomen)
What is Oro-Facial Granulomatosis
What condition is this oral manifestation linked with?
Predominantly labial swelling associated with granulomatous inflammation
May precede GIT manifestation of Crohn’s (early diagnosis)
What is Plummer-Vinson syndrome?
Rare disease characterised by
- Dysphagia (difficulty swallowing)
- Post-Cricoid web (Mechanical Block of throat)
- Iron-deficiency anaemia
- Glossitis
People with this have an increased chance of esophageal cancer
What vitamin is an essential co-factor in collagen synthesis?
Vitamin C
Integrity of oral mucosa is dependent on complex interplay of what 3 factors?
Nutritional
Metabolic
Hormonal
What is Crohn’s Disease?
Chronic inflammatory bowel disease affecting whole GIT
Discontinuous pattern of transmural inflammation
What is the normal epethelial turn over for skin?
50-70 days
What is the normal epithelial turn over for the buccal mucosa?
25 days
Much faster than skin which is 50-70 days
