L4 Perio-Oral medicine interface Flashcards
What does perio-oral med interface describe?
The effect of systemic disease on the periodontium.
How can we classify systemic conditions which affect the periodontium?
- Conditions that influence the coures of periodontitis by influencing periodontal inflammation. Can be genetic, immunodeficiency disorders, inflammatory, and other systemic disease.
- Conditions that affect the periodontal supporting tissue independent of biofilm induced inflammation. These conditions are not actually gingivitis or periodontitis. Can be primary neoplasms, secondary metastatic neoplasms and other disorders.
Categorise genetic disorders which influence the course of periodontitis (via. influecing perio inflammation).
Blue writing indicates the strength of association between the condition and periodontitis. No writing = strong association.
What is Trisomy 21 and how does it affect oral health?
- Down’s syndrome
- Delayed eruption
- Malocclusion
- Crowding
- Hypodontia
- Significant amounts of bone loss in perio
- Periodontitis has been reported in 50% of pts with Down’s syndrome
What is epidermolysis bullosa and how does it affect the periodontium?
- Rare blistering disorder of the skin and mucous membranes
- Blisters can occur with very minor trauma (pathergy)
- Struggle to carry out OHI due to blistering and pain
- Periodontitis tends to be much more severe and rapidly progressing
- Can see significant bone loss in these images for a 16 year old
What is plasminogen deficiency and how does it affect oral health?
- Rare genetic condition causing plasminogen deficiency
- Causes thick, inflammed growths of the mucosa
- Thick lining on gingival tissues
- Significant bone loss
- Vertical bone defects surrounding membranes
- Severe and rapid progression of periodontitis
What is Ehlers-Danlos syndrome and how does it affect oral health?
- Connective tissue disorder
- Hypermobility of joints
- Results in more severe and rapidly progressing periodontitis
Do acquired immunodeficiency disorders influence periodontal inflammation?
Inconclusive.
- Acquired neutropenia = weak association
- HIV infection = weak association
Which inflammatory diseases are associated with influencing periodontitis?
- Epidermolysis bullosa acquisita: moderate association
- Inflammatory bowel disease: strong association
- Arthritis: strong association
Influence the course of perio by influencing periodontal inflammation.
Name other systemic disorders linked to periodontitis and how strong their association is.
- Emotional stress and depression: weak
- Hypertension: inconclusive evidence
- Smoking: strong association
Which medications increase the amount of destruction in periodontitis?
- Chemotherapy
- VEGF inhibitors
- TKIs (sunitinib)
Which medications decrease the amount of destruction in periodontitis?
- NSAIDs
- Anti-TNF therapies
- Bisphosphonates
Which neoplasms have been found to cause loss of periodontal tissue independent of periodontititis?
Moderate association:
- Primary cancer: SCC, malignant odontogenic tumours
- Secondary metastatic neoplasms
Name other systemic disorders that have been found to cause loss of periodontal tissue independent of periodontitis.
- Langerhans cell histiocytosis
- Granulomatosis with polyangiitis
- Giant cell granuloma
- Hyperparathyroidism
- Systemic sclerosis
- Vanishing bone disease (Gorham-Stout syndrome)
Name 10 conditions of non-biofilm related loss of periodontal tissue.
- Lichen planus
- Primary herpetic gingivostomatitis
- Pregnancy epulis
- Orofacial granulomatosis
- Pemphigus vulgaris
- Graft vs host disease
- Bullous pemphigoid
- Amalgam tattoo
- Thrombocytopenia
- Langerhans cell histiocytosis
- Moderately differentiated SCC
How is lichen planus managed?
- May need biopsy to exclude lupus, lichenoid reaction, pemphigus and pemphigoid (Dr Atkin would disagree)
- Treated with topical or systemic corticosteroids
- Regular monitoring is required since oral lichen planus is classified as a potentially malignant disorder
How would you treat the gingival lesions that this patient with lichen planus has?
Soft splint with gingival coverage (like a night guard) to apply topical corticosteroid for 10 minutes daily for 6 weeks- Fluocinolone acetonide.
Describe the presentation of primary herpetic gingivostomatitis.
- Manifestation of HSV-1 in children
- Acute onset of very painful mouth and swollen gingivae
- Raised temp, generally feeling unwell
- Gingival tissue affected regardless of plaque presence
- Widespread ulcers
- Crusting of lips
- Lymphadenopathy
Describe pregancy epulis.
- Excisional biopsy required to confirm diagnosis
- Although it is likely to be an epulis biopsy is still required to eliminate other possible diagnoses
- Will resolve post-birth
- May recur whilst pregnancy continues if removed
Describe pemphigus vulgaris.
- Rare autoimmune condition characterised by blistering of skin and mucous membranes
- Blistering extends beyond the mucogingival junction (tells you that inflammation is not plaque induced)
- Pts develop antibodies to desmosomes in the epithelium of mucous membranes and skin, causes blistering
- More common to see blisters in loose mucosa rather than gingival tissues
- DO NOT attempt Nikolsky’s sign (applying pressure to blister to see if shearing occurs) as it will make the ulcer larger and cause pain
Describe Graft vs Host disease.
- A proces that can occur following a bone marrow or stem cell transplant
- Diagnosis based on history taking
- Patients present with generalised oral discomfort, swollen gums and widespread ulceration
- Biopsy required, may mimic other conditions
Describe Bullous Pemphigoid.
- Rare autoimmune condition similair to pemphigus vulgaris
- Blistering, inflammation progressing beyond mucogingival junction, split epithelium from underlying CT
Describe thrombocytopenia.
- Reduced platelet count
- Below 150×10^9/L is considered a medical emergency
- FBC and bone marrow examination
- Many causes e.g. Leukaemia or a drug reaction
- Platelet transfusion required
Describe Langerhans’ cell histiocytosis.
- Very rare condition
- Excess histiocytes = multiple granulomas
- Symptoms/signs range from: a rash, lumps on the skull, swollen tummy, breathing difficulties
Describe moderately differentiated gingival SCC.
- Pt underwent right sided marginal mandibulectomy of LR4/5 region with level 5 radical neck dissection
What is the surgical sieve? HIIINTS
Mnemonic to help to remember conditions discuess in this lecture.
