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4th yr- CMS- The Oral Cavity > Oral Manifestation of Systemic Disease > Flashcards

Oral Manifestation of Systemic Disease Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

Give examples of systemic diseases that can manifest in the oral cavity

A
  1. Acromegaly
  2. Neurofibromatosis
  3. Anaemia
  4. Haematinic Deficiencies
  5. Leukaemia
  6. Granulomatous disease
  7. Tuberculosis
  8. Syphilis
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2
Q

What is Acromegaly

A

A rare disease of excesses growth hormone production

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3
Q

What is Acromegaly due to

A

Pituitary adenoma

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4
Q

How rare is Acromegaly

A

3 in a million

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5
Q

What happens in Acromegaly

A
  1. Hands, feet, jaw, all grow larger or longer
  2. Show size can go up
  3. Hands feel soft and doughy appearance
  4. Facial features can become coarser and dentures may not fit
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6
Q

What are the risks of long term untreated Acromegaly

A
  1. CVD
  2. T2DM
  3. Arthritis
  4. Bowel polyps
  5. Cardiomyopathy
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7
Q

What is neurofibromatosis

A

Is a common genetic condition

It is an autosomal dominant condition

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8
Q

How many types of neurofibromatosis

A
  1. NF1

2. NF2 (More common)

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9
Q

How common Is neurofibromatosis

A

1 in 2500

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10
Q

What are the oral manifestations of neurofibromatosis

A
  1. Submucosal or subcutaneous swellings
  2. Pronounced frackling of the axillae and groin
    These lesions can increase as the patient ages
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11
Q

What are the common oral presentations of anaemia

A
  1. Angular chelitiis
  2. Depapillation of the tongue
  3. Erythema/ inflammation of the tongue
  4. Oral ulcerations of the aphthous
  5. Oral candisosis
  6. Oral dysaesthesias
  7. Mucosal pallor
  8. Plummer vinson syndrome
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12
Q

What are haematinics

A

Measurments of folate, ferritin and b12

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13
Q

What can haematinic Deficiencies be present with

A

anaemia

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14
Q

List some of the oral manifestations of haematinic Deficiencies

A
  1. Aphthous ulceration
  2. Recurrent/ persistent oral candidosis
  3. Burning mouth syndrome or oral dysaesthesias
  4. transitory red patches that may be sore
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15
Q

How can leukaemia present in the mouth

A
  1. As inappropriate bleeding and unexpected degrees of oedematous swelling
  2. Oral ulcerations
  3. Gingival hypertrophy
  4. Lymphadenopathy
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16
Q

Why do oral ulcerations form in leukaemia

A

Due to neutropenia

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17
Q

What is granulomatous disease

A

Presence of granulomas in the tissues seen on histopathology

18
Q

Give examples of granulomatous disease

A
  1. Crohn’s disease
  2. orofacial granulomatosis
  3. sarcoidosis
19
Q

How does oral granulomatosis present

A

With a combination of classic ora symptoms eg:

  1. linear sulcal ulcers,
  2. gingival inflammation,
  3. mucosal tagging,
  4. cobblestoning of the buccal mucosa,
  5. palatal mucosal hypertrophy,
  6. staghorning of the submandibular glands,
  7. fissuring of the tongue,
  8. lip swelling,
  9. lip fissures,
  10. facial discolouration
20
Q

What can oral granulomatosis be confused with

A

Crohn’s disease

21
Q

What can granulomatous disease be due to

A
  1. Foreign bodies in the oral tissue

2. Bacterial infection

22
Q

What is Sarcoidosis

A

It is a multi system disease of unknown cause characterised by non caseating granulomata

23
Q

As a GDP if you see a patient with oral granulomatosis what should you do

A
  1. Patient education
  2. Prevention of superinfection
  3. Protection of healing ulcers
  4. Topical analgesia
  5. Refer to oral medicine if needed
24
Q

How do we prevent superinfection in a patient with oral granulomatosis

A

10mls 0.2% chlorhexidene mouthwash 2-3 times daily

25
Q

How do we protect the healing ulcers

A
  1. OTC or prescribed oral mucosal coating agents such as gengigel gelclair
26
Q

What topical analgesia may you give to a patient with oral granulomatosis

A
  1. Difflam mouthwash or spray

2. Lidocaine gel or spray

27
Q

Whta actions does oral medicine take to treat a patient with oral granulomatosis

A
  1. Treat active ulcers
  2. Adjunctive topical agents
  3. Escalating treatment for partial/ non responding ulcers
  4. Steroid sparing agents
28
Q

How can tuberculosis manifest in the oral cavity

A
  1. Gingival hypertrophy

2. Oral ulcerations

29
Q

How does primary syphilis present orally

A

With a chancre

30
Q

How does secondary syphilis present orally

A
  1. Produces mucosal patches that can coalesce to form snail track ulcers,
  2. rubbery non painful generalised lymphadenopathy
  3. maculopapular rash on the skin
31
Q

How does tertiary syphilis present orally

A

a “gumma” is the classic oral lesion which is the granulomatous one that starts as a nodule but tissue destruction locally follows;

32
Q

If a patient has a persistent oral ulceration what could that be

A
  1. SCC
  2. Syphilis
  3. TB
  4. Trauma
  5. OLP
  6. Chemotherapy
33
Q

If a patient has a recurrent oral ulceration what could that be

A
  1. Aphthae
  2. HSV infection
  3. Dermatitis
  4. Erythema multiform
34
Q

What questions should you ask yourself during the medical history if a patient complains of an oral ulceration

A
  1. Does the patient have any known diagnoses that can explain the orofacial findings?
  2. Are they on a medication which may cause orofacial side effects?
  3. Do they smoke, use tobacco products or drink alcohol?
  4. Is there any family history of hereditary disorders?
35
Q

If a patient presents with white/ red or mixed patches what might they have

A
  1. Oral lichen planus secondary to long term sulphonylurea use for type 2 diabetes
  2. Recurrent or persistent erythematous candidosis secondary to undiagnosed HIV infection
36
Q

If a patient presents with changes in oral mucosal pigment what might they have

A
  1. Perioral hyperpigmented macules secondary to Peutz Jeghers syndrome that means patient may have colonic polyps that are more likely to turn malignant
  2. One or multiple purple/red/black areas of irregular pigmentation in the oral mucosa or orofacial skin indicating Kaposi’s sarcoma, a potentially AIDs defining diagnosis in a HIV positive patient
37
Q

If a patient presents with an oral ulceration what might they have

A
  1. Minor recurrent aphthous stomatitis secondary to coeliac disease
  2. Persistent/chronic solitary oral ulcer due to prescription of nicorandil for poorly controlled ischaemic heart disease (or simply an increase in the dose of this drug)
38
Q

If a patient presents with lumps and bumps (swellings) what might they have

A
  1. Hyperplastic submandibular gland ducts due to orofacial granulomatosis
  2. Cervical lymphadenopathy due to non-Hodgkin’s lymphoma
39
Q

If a patient presents with salivary gland disorder what might they have

A
  1. Hypersalivation seen in Parkinson’s disease

2. Xerostomia due to radiotherapy to the neck for lymphoma or thyroid cancer

40
Q

If a patient presents with orofacial pain what might they have

A
  1. Oral dysaesthesias secondary to poorly controlled diabetes or undiagnosed thyroid disease
  2. Trigeminal neuralgia secondary to multiple sclerosis

4th yr- CMS- The Oral Cavity (6 decks)

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