Influence of diet & GI disease on the oral mucosa Flashcards
What can mild iron, B12 or folate deficiencies cause?
Generalised oral epithelial atrophy & depapillation of dorsum of tongue
Altered oral epithelial cell metabolism => abnormal cell structure & keratinisation
Sensitivity of filiform papillae (tongue) => soreness (e.g. triggered by acidic/spicy foods), reduced taste sensation, ulceration & candidosis
What 5 oropharyngeal conditions are associated with haematinic deficiencies?
Glossitis
Angular cheilitis & candidosis
ROU
Burning mouth
Plummer-Vinson/Paterson-Kelly Syndrome
What are the 2 different types of glossitis & what do they indicate?
Smooth & depapillated (iron deficiency)
Raw & beefy-red (vitamin B12 & folate deficiency)
How do you manage ROU due to haematinic deficiencies?
Supplements
What is Plummer-Vinson/Paterson-Kelly Syndrome characterised by?
Dysphagia
Post-cricoid web
Iron-deficiency anaemia
Glossitis
Increased risk of pharyngeal or oral cancer
Why is vitamin C important?
It is an essential co-factor in collagen synthesis
Clinical features of vitamin C/ascorbic acid deficiency?
Initially - enlargement & keratosis of hair follicles = ‘cork-screw hairs’
Later (weeks) - blood vessel proliferation around hair follicles & interdental papillae => gingival hyperplasia & haemorrhage
Tooth mobility & exfoliation
Cutaneous bleeding & purpura (bruising)
What is zinc responsible for?
Enzymes - responsible for gene expression, hormone function & cell-mediated immunity
Clinical features of zinc deficiency?
Pustular bullous dermatitis
Alopecia
Diarrhoea/poor appetite
Growth retardation
Lethargy/depression
Male hypogonadism
Poor wound healing & infection risk
Oral features of zinc deficiency?
Dys/hypogeusia (reduced taste)
Angular cheilitis
Superficial aphthous-like ulcers
Candida superinfection
Delayed wound healing
Perioral psoriasiform/mild eczematous eruption
Erythema migrans/benign migratory glossitis/geographic tongue
What affect does protein-energy malnutition (PEM) have?
Impaired specific & non-specific immunity/ascorbate deficiency/increased levels of free corticosteroids in blood & saliva
Oral features of alcoholism?
Sialosis (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) & malnutrition
Effect of retinol/zinc deficiencies?
Diminished cell-mediated immunity/early oral mucosa breakdown & loss of integrity
What is bulimia nervosa?
Repeated bouts of overeating (twice or more a week for 3+ months) with an excessive preoccupation regarding control of body weight, e.g. induced vomiting/diarrhoea to avoid perceived weight gain
Oral features of bulimia nervosa?
Sialosis
Dental erosion
Russell’s sign (calluses on dorsum of hand from induced vomiting
Ulcers on soft palate
Angular cheilitis (from haematinic deficiencies)
Weight is often in normal range, repeated vomiting may lead to hypokalaemia (reduced potassium levels) observed in FBC
Risk factors for acute necrotising ulcerative gingivitis?
Malnutrition
Poor OH
Smoking
Stress
Immunocompromised
Aetiology of necrotising stomatitis (NOMA)?
Bacterial infection similar to ANUG
Risk factors for NOMA?
Malnutrition
Poor OH
Malaria
Measles
Immunocompromised (e.g. AIDS, chicken pox, CMV)
Close residential proximity to livestock
Clinical features of NOMA?
Foul breath & rapid devastating necrotic destruction of soft & hard orofacial tissues
Acute => oedema, necrotising stomatitis, cheek perforation & secondary infection
Chronic => fibrous scar, oral strictures, trismus, dental malposition & salivary incontinence
What is coeliac disease/gluten sensitive enteropathy & its risk factors?
Chronic inflammatory auto-immune reaction of the small intestine => permanent intolerance/ hypersensitivity to alpha-gliadin in gluten (e.g. wheat, oats, rye & barley)
Risk factor = genetic
Clinical features of coeliac disease?
Malabsorption => fatigue & anaemia
Chronic diarrhoea
Weight loss
Abdominal distension
(Less common) Infertility, AI diseases & malignancies
Oral features of coeliac disease?
Dental hypoplasia (symmetrical enamel defects, mainly mild - rough surface with horizontal grooves or shallow pits)
ROU/cheilitis (major, minor or herpetiform ulceration; may be genetic predisposition)
Glossitis/burning mouth
Angular cheilitis
Exacerbation of lichen planus
AI diseases (Sjögren’s or diabetes)
Malignancies (Oesophageal & oropharyngeal SCC)
What is coeliac disease associated with?
Dermatitis herpetiformis (pruritic vesiculopapular rash, middle-aged males, 70% have oral lesions)
Linear IgA disease (bullous-pemphigoid like blistering)
Selective IgA deficiency
What is Crohn’s disease?
Chronic inflammatory bowel disease affecting whole GIT (involving both small & large intestine) => discontinuous pattern of transmural inflammation with large ulcers & occasional granuloma
Aetiology of Crohn’s disease?
Genetic (NOD2)
Environmental (enteric microflora & nutrition)
Host immune response
Nutritional risk factors for Crohn’s disease?
Lack/absence of infant breastfeeding (protective effects)
Allergy to milk proteins
Increased consumption of refined CHO or added sugar
Decreased fruit/vegetable consumption
Intake of chemically processed fats
Specific oral lesions to Crohn’s disease?
Indurated tag-like mucosal lesions
‘Cobblestone’ mucosa
Mucogingivitis
Lip swelling - soft, diffuse & non-tender with vertical fissures
Deep linear ulceration
Non-specific lesions of Crohn’s disease?
ROU
Pyostomatitis vegetans
Angular cheilitis
Glossitis
Persistent submandibular lymphadenopathy
What is oro-facial granulomatosis?
Predominantly labial swelling associated with granulomatous inflammation
