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Oral Medicine > Influence of diet & GI disease on the oral mucosa > Flashcards

Influence of diet & GI disease on the oral mucosa Flashcards

1
Q

What can mild iron, B12 or folate deficiencies cause?

A

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

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2
Q

What 5 oropharyngeal conditions are associated with haematinic deficiencies?

A

Glossitis

Angular cheilitis & candidosis

ROU

Burning mouth

Plummer-Vinson/Paterson-Kelly Syndrome

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3
Q

What are the 2 different types of glossitis & what do they indicate?

A

Smooth & depapillated (iron deficiency)

Raw & beefy-red (vitamin B12 & folate deficiency)

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4
Q

How do you manage ROU due to haematinic deficiencies?

A

Supplements

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5
Q

What is Plummer-Vinson/Paterson-Kelly Syndrome characterised by?

A

Dysphagia
Post-cricoid web
Iron-deficiency anaemia
Glossitis
Increased risk of pharyngeal or oral cancer

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6
Q

Why is vitamin C important?

A

It is an essential co-factor in collagen synthesis

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7
Q

Clinical features of vitamin C/ascorbic acid deficiency?

A

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)

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8
Q

What is zinc responsible for?

A

Enzymes - responsible for gene expression, hormone function & cell-mediated immunity

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8
Q

Clinical features of zinc deficiency?

A

Pustular bullous dermatitis

Alopecia

Diarrhoea/poor appetite

Growth retardation

Lethargy/depression

Male hypogonadism

Poor wound healing & infection risk

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8
Q

Oral features of zinc deficiency?

A

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

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9
Q

What affect does protein-energy malnutition (PEM) have?

A

Impaired specific & non-specific immunity/ascorbate deficiency/increased levels of free corticosteroids in blood & saliva

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10
Q

Oral features of alcoholism?

A

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

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10
Q

Effect of retinol/zinc deficiencies?

A

Diminished cell-mediated immunity/early oral mucosa breakdown & loss of integrity

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10
Q
A
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11
Q

What is bulimia nervosa?

A

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

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12
Q

Oral features of bulimia nervosa?

A

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

13
Q

Risk factors for acute necrotising ulcerative gingivitis?

A

Malnutrition

Poor OH

Smoking

Stress

Immunocompromised

13
Q

Aetiology of necrotising stomatitis (NOMA)?

A

Bacterial infection similar to ANUG

14
Q

Risk factors for NOMA?

A

Malnutrition

Poor OH

Malaria

Measles

Immunocompromised (e.g. AIDS, chicken pox, CMV)

Close residential proximity to livestock

14
Q

Clinical features of NOMA?

A

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

14
Q

What is coeliac disease/gluten sensitive enteropathy & its risk factors?

A

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

15
Q

Clinical features of coeliac disease?

A

Malabsorption => fatigue & anaemia

Chronic diarrhoea

Weight loss

Abdominal distension

(Less common) Infertility, AI diseases & malignancies

16
Q

Oral features of coeliac disease?

A

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)

17
Q

What is coeliac disease associated with?

A

Dermatitis herpetiformis (pruritic vesiculopapular rash, middle-aged males, 70% have oral lesions)

Linear IgA disease (bullous-pemphigoid like blistering)

Selective IgA deficiency

18
Q

What is Crohn’s disease?

A

Chronic inflammatory bowel disease affecting whole GIT (involving both small & large intestine) => discontinuous pattern of transmural inflammation with large ulcers & occasional granuloma

19
Q

Aetiology of Crohn’s disease?

A

Genetic (NOD2)

Environmental (enteric microflora & nutrition)

Host immune response

20
Q

Nutritional risk factors for Crohn’s disease?

A

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

21
Q

Specific oral lesions to Crohn’s disease?

A

Indurated tag-like mucosal lesions

‘Cobblestone’ mucosa

Mucogingivitis

Lip swelling - soft, diffuse & non-tender with vertical fissures

Deep linear ulceration

22
Q

Non-specific lesions of Crohn’s disease?

A

ROU

Pyostomatitis vegetans

Angular cheilitis

Glossitis

Persistent submandibular lymphadenopathy

23
Q

What is oro-facial granulomatosis?

A

Predominantly labial swelling associated with granulomatous inflammation

Oral Medicine (9 decks)

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