NUTRITIONAL GI DISEASE Flashcards
Haematinic deficinecies (iron, B12, folate) effects on the oral cavity
-Glossitis (smooth depapillated tongue -> Fe raw beefy red-> B12 folate)
-angular cheilitis and candidosis
-Recurrent oral ulceration (20% of ROU pt have haematinic deficiency)
-Burning mouth SYMPTOMS
-Patterson Kelly Syndrome -dysphagia
+reduced taste sensation
lead to premalignant lesions
What is Patterson Kelly Syndrome
-Females
-Fe deficiency anaemia
-post cricoid web (increasing risk of pharyngeal + oral carcinoma)
-> dysphagia
-glossitis - depapillation of tongue+soreness
this is a pre-malignant condition
-koilonychia
Oral features of alcoholism
- Sialosis/Sialodenosis
- Dental erosion secondary to acid reflux (normally palatally)
- OSCC
- Malnutrition
- Liver cirrhosis = easy ecchymosis and yellow appearance in mouth and can be linked to platelet dysfunction(?)
What is Bulimia nervosa
-Repeated bouts of overeating and being engrossed with controlling body weight
repeated= 2+ week for 3 months
Clinical ft of bulimia nervosa
- Weight is normal (due to purging)
- repeated vomitting=hypokalaemia
- Dental erosion (normally palatally)
- Calluses on dorsum on the hand= Russells sign
- ulcers on soft palate
- angular chelitis
- sialosos/sialodenosis
Acute necrotising ulcerative gingivitis (ANUG)
- Non contagious anaerobic infection associated with prevotella and fusobacterium
- Painful sloughing
- ulcerative punched out interdental papilla
- gingival bleeding
- halitosis of ROTTEN HAY
- sialorrhea (drooling)
- in malnurished/immunocompromised patients this can spread to oral mucosa and skin =cancrum oris
Predisposing factors to ANUG
- smoking
- Viral respiratory infection
- Poor OH
- Malnutrition
- low socioeconomic background
- Immunodeficiency eg. HIV
- Stress
Management of ANUG
- OHI
- Oral debridement
- Oxidising mouthwash (Peroxyl) like in black hairy tongue
- Periodontal assessment
Necrotising stomatitis - NOMA
-Malnourished/immunosuppressed children in developing countries
-putrid oral malodour
-rapid devastating necrotising destruction (ST/HT and orofacial tissue)
acute=oedema, necrotizing stomatitis, cheek perforation-> sepsis=death
chronic= fibrous scar, oral strictures, trismus, dental malposition, salivary incontinence
Reasons for NOMA +predisposing factors
BACTERIAL INFECTION
- ANUG
- anaerobic bacteria eg. fusobacterium prevotella
PREDISPOSING FACTORS
- poor OH
- Poverty
- Debilitating diseases
- Malaria
- Malnutrition
Vitamin C/ascorbic acid deficiency
-also known as scurvy
-essential in collagen synthesis
-initially: cork screw hairs (hair follicles enlarge+keratosis)
within weeks: bv proliferation around hair follicles & interdental papilla = gingival hyperplasia + haemorrhage
tooth mobility+exfoliation
cuntaneous bleeding and purpura
Zinc deficiency
- important in cell mediated immunity, hormone function, gene expression
- ZN found in meat fish dairy
- common in elderly
ZN deficiency clinical ft (other than orally)
- alopecia
- poor apetite+ diarrhea
- poor wound healing
- depression
- growth retardation
- male hypogonadism
clinical features of Zn deficiency (oral)
- GEOGRAPHIC TONGUE/benign migratory glossitis
- CANDIDA SUPERINFECTION
- hypogeusia
- angular chelitis
Benign migratory glossitis associations
- ZN DEFICIENCY
- allergies eg. hay fever
- GI disorders
- xs lithium
- pregnancy
- Type 1 diabetes melliuts
- seborrheoic dermatitis
if hypogeusia is not due to Zn
do not give zn supplements
xs zn= increased copper excretion
What is Coeliac disease
- chronic inflammation of SI induced by gluten
- malabsorbtion
- diarrhoea
- fatigue
- anaemia (haemetinic deficiencies)
- delayed presentation
Coeliac disease oral lesions
- ROU
- DENTAL HYPOPLASIA
- HAEMATINIC DEFICIENCIES -> glossitis, angular chelitis, candida, Burning mouth symptoms/ stomatitis
- Exacerbation of LP
Dental hypoplasia associated with
-coeliac disease
ROU is associated with
- Haematinic defiencies
- Bechets disease
- Coeliac disease+crohns disease- GIT diseases
Crohns disease aetiology
also known as inflammatory bowel disease
aetiology unknow but probably: genetic environment and host immunity causing inflammation
Crohns disease (Specific and non-specific lesions)
SPECIFIC LESIONS
- cobblestoning of the oral mucosa
- ulcerative fissures
- mucosal tags
- mucogingivitis
- lip swelling w/ vertical fissures
NON-SPECIFIC LESIONS
- pyostomatitis vegetans
- angular chelitis
- ROU
- glossitis
- lymphadenopathy
Orofacial granulomatosis clinical features
granulomatous inflammation +labial swelling
lymphadenopathy (submandibular and cervical)
sensitive to benzoates (preservities)
angular chelitis
mucosal ulceration
-melkerson rosenthal syndrome
Melkerson rosenthal syndrome
- associated with patients with OFG
- Fissured tongue
- LMN palsy of CN7
OFG management
elimination of diets eg. benzoates and cinammon
topical corticosteroids eg. betamethasone 500mcg soluble tablets
topical tacrolimus ointment 0.1%
Peutz Jeghers syndrome
-Rare autosomal dominant syndrom
-Mutation in the LKB1 and ch19 coding for serine-threonine kinase (plays a role in apoptosis)
-melanotic macules around vermillion border and perioorally
+intra orally= these are benign
-Haemtomatous polyps colorectally + abdominal and rectal bleeding which increase malignancy risk
