Oral Manifestation of Systemic Disease Flashcards
Give examples of systemic diseases that can manifest in the oral cavity
- Acromegaly
- Neurofibromatosis
- Anaemia
- Haematinic Deficiencies
- Leukaemia
- Granulomatous disease
- Tuberculosis
- Syphilis
What is Acromegaly
A rare disease of excesses growth hormone production
What is Acromegaly due to
Pituitary adenoma
How rare is Acromegaly
3 in a million
What happens in Acromegaly
- Hands, feet, jaw, all grow larger or longer
- Show size can go up
- Hands feel soft and doughy appearance
- Facial features can become coarser and dentures may not fit
What are the risks of long term untreated Acromegaly
- CVD
- T2DM
- Arthritis
- Bowel polyps
- Cardiomyopathy
What is neurofibromatosis
Is a common genetic condition
It is an autosomal dominant condition
How many types of neurofibromatosis
- NF1
2. NF2 (More common)
How common Is neurofibromatosis
1 in 2500
What are the oral manifestations of neurofibromatosis
- Submucosal or subcutaneous swellings
- Pronounced frackling of the axillae and groin
These lesions can increase as the patient ages
What are the common oral presentations of anaemia
- Angular chelitiis
- Depapillation of the tongue
- Erythema/ inflammation of the tongue
- Oral ulcerations of the aphthous
- Oral candisosis
- Oral dysaesthesias
- Mucosal pallor
- Plummer vinson syndrome
What are haematinics
Measurments of folate, ferritin and b12
What can haematinic Deficiencies be present with
anaemia
List some of the oral manifestations of haematinic Deficiencies
- Aphthous ulceration
- Recurrent/ persistent oral candidosis
- Burning mouth syndrome or oral dysaesthesias
- transitory red patches that may be sore
How can leukaemia present in the mouth
- As inappropriate bleeding and unexpected degrees of oedematous swelling
- Oral ulcerations
- Gingival hypertrophy
- Lymphadenopathy
Why do oral ulcerations form in leukaemia
Due to neutropenia
What is granulomatous disease
Presence of granulomas in the tissues seen on histopathology
Give examples of granulomatous disease
- Crohn’s disease
- orofacial granulomatosis
- sarcoidosis
How does oral granulomatosis present
With a combination of classic ora symptoms eg:
- linear sulcal ulcers,
- gingival inflammation,
- mucosal tagging,
- cobblestoning of the buccal mucosa,
- palatal mucosal hypertrophy,
- staghorning of the submandibular glands,
- fissuring of the tongue,
- lip swelling,
- lip fissures,
- facial discolouration
What can oral granulomatosis be confused with
Crohn’s disease
What can granulomatous disease be due to
- Foreign bodies in the oral tissue
2. Bacterial infection
What is Sarcoidosis
It is a multi system disease of unknown cause characterised by non caseating granulomata
As a GDP if you see a patient with oral granulomatosis what should you do
- Patient education
- Prevention of superinfection
- Protection of healing ulcers
- Topical analgesia
- Refer to oral medicine if needed
How do we prevent superinfection in a patient with oral granulomatosis
10mls 0.2% chlorhexidene mouthwash 2-3 times daily
How do we protect the healing ulcers
- OTC or prescribed oral mucosal coating agents such as gengigel gelclair
What topical analgesia may you give to a patient with oral granulomatosis
- Difflam mouthwash or spray
2. Lidocaine gel or spray
Whta actions does oral medicine take to treat a patient with oral granulomatosis
- Treat active ulcers
- Adjunctive topical agents
- Escalating treatment for partial/ non responding ulcers
- Steroid sparing agents
How can tuberculosis manifest in the oral cavity
- Gingival hypertrophy
2. Oral ulcerations
How does primary syphilis present orally
With a chancre
How does secondary syphilis present orally
- Produces mucosal patches that can coalesce to form snail track ulcers,
- rubbery non painful generalised lymphadenopathy
- maculopapular rash on the skin
How does tertiary syphilis present orally
a “gumma” is the classic oral lesion which is the granulomatous one that starts as a nodule but tissue destruction locally follows;
If a patient has a persistent oral ulceration what could that be
- SCC
- Syphilis
- TB
- Trauma
- OLP
- Chemotherapy
If a patient has a recurrent oral ulceration what could that be
- Aphthae
- HSV infection
- Dermatitis
- Erythema multiform
What questions should you ask yourself during the medical history if a patient complains of an oral ulceration
- Does the patient have any known diagnoses that can explain the orofacial findings?
- Are they on a medication which may cause orofacial side effects?
- Do they smoke, use tobacco products or drink alcohol?
- Is there any family history of hereditary disorders?
If a patient presents with white/ red or mixed patches what might they have
- Oral lichen planus secondary to long term sulphonylurea use for type 2 diabetes
- Recurrent or persistent erythematous candidosis secondary to undiagnosed HIV infection
If a patient presents with changes in oral mucosal pigment what might they have
- Perioral hyperpigmented macules secondary to Peutz Jeghers syndrome that means patient may have colonic polyps that are more likely to turn malignant
- 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
If a patient presents with an oral ulceration what might they have
- Minor recurrent aphthous stomatitis secondary to coeliac disease
- 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)
If a patient presents with lumps and bumps (swellings) what might they have
- Hyperplastic submandibular gland ducts due to orofacial granulomatosis
- Cervical lymphadenopathy due to non-Hodgkin’s lymphoma
If a patient presents with salivary gland disorder what might they have
- Hypersalivation seen in Parkinson’s disease
2. Xerostomia due to radiotherapy to the neck for lymphoma or thyroid cancer
If a patient presents with orofacial pain what might they have
- Oral dysaesthesias secondary to poorly controlled diabetes or undiagnosed thyroid disease
- Trigeminal neuralgia secondary to multiple sclerosis
