Oral Manifestations (1) Flashcards
Name 4 neurological conditions
- Multiple sclerosis
- Trigeminal Neuralgia
- Hypoglossal Nerve Palsy
- Facial Nerve Palsy
Describe multiple sclerosis
- Chronic inflammatory disease of the CNS
- Thought to be idiopathic (autoimmune)
- F > M
Describe 4 classifications of multiple sclerosis
- Acute
- Subacute
- Relapse
- Progressive
Describe the aetiology and pathogenesis of multiple sclerosis
- Plaques and demyelination of axons
- Variable symptomology including dysesthesia, balance coordination, vertigo and optic disturbances
Describe trigeminal neuralgia
- Episodic neuropathic pain
- Sudden unilateral, severe, brief stabbing, recurrent episodes of pain in distribution of one or more branches of trigeminal nerve
- F > M
- 45-59 years
Describe the aetiology and pathogenesis of trigeminal neuralgia
- Areas of demyelination or vascular compression, but unsure on cause
- Pathology related to HIV, vascular aneurysm or neoplasm
Describe hypoglossal nerve palsy
- Rare
- Deviation to affected side
- Fasciculation of affected side
Name 5 causes of hypoglossal nerve palsy
- Idiopathic
- Metastatic disease at base of skull
- Medical causes
- Trauma
- Meningioma
Describe facial nerve palsy
- Swelling of facial nerve due to virus aetiology
- May be caused by Herpes Simplex
- Upper or lower motor neurone lesion can be cause
Name 4 classifications of respiratory disease
- Obstructive
- Restrictive
- Perfusion
- Lung Cancers
Name 4 oral manifestations of respiratory disease
- Dental caries
- Dental erosion
- Periodontal disease
- Oral candidiasis
Describe the clinical features of pseudomembranous candidiasis
- Creamy plaques
- Large areas of the oral mucosa
- May be wiped off
- Erythematous mucosa
Describe the clinical features of erythematous candidiasis
- Red areas of the tongue and palate
- Can be painful
Describe tuberculosis
- Chronic infectious disease caused by mycobacterium tuberculosis
- Nine million people affected
- Lung main organ affected but may have extra pulmonary involvement
Describe the oral implications of tuberculosis
- Oral TB is uncommon (0.1% to 5.0%)
- Primary or secondary in occurrence
- Any oral site affected
- Men > Women
What is sarcoidosis?
- Multi-systemic chronic granulomatous condition
- Cause unknown but thought to be immune response to bacterial infection
- 3,000 new cases diagnosed yearly
- Young adults aged 20-40 years
Describe the common sites affected by sarcoidosis
- All organ system
- Lungs and lymph nodes affected
Describe 5 symptoms of sarcoidosis
- Flu-like sypmtoms
- Lupus pernio
- Blue-ish/purple plaque like lesions
- Pathognomonic
- Uveitis
Describe the oral implications of sarcoidosis
- Oral involvement rare
- Swellings may be present
- Salivary gland swelling
Name 4 common issues with cardiovascular system
- Ischaemic heart disease
- Heart failure
- Congenital heart failure
- Valvular defects
Describe 4 common oral manifestations of cardiovascular disease
- Pain in orofacial region can occur during MI
- Colour changed
- Pathological changes
- Medication
Describe oral varices
- Most commonly seen on ventral surface of tongue and floor of mouth
- Abnormally dilated veins
- Tend to become more prominent with age
- Asymptomatic and blanch on diascopy
Name 6 common drug reactions from common cardiovascular drugs
- Burning mucosa (ACE inhibitors e.g ramipril)
- Swellings
- Dry mouth (Diuretics e.g furosemide)
- Ulceration (GTN spray)
- Gingival hyperplasia (Calcium channel blockers e.g amlodipine)
- Haemorrhagic lesions
Name 3 types of haemorrhagic lesions caused by cardiovascular drugs
- Petechiae
- Purpura
- Ecchymosis
Describe coeliac disease
- Immune mediated condition
- Ingestion in wheat in genetically susceptible individual
- Any age with 2 peaks
- Increased incidence of autoimmune disease and atopy
Name 5 typical presentations of coeliac disease
- Abdominal pain
- Chronic diarrhoea
- Vomiting
- Weight loss
- Abdominal distension
Name 3 atypical presentations of coeliac disease
- Fatigue
- Iron deficiency anaemia
- Dermatitis herpetiformis
Describe 4 tooth related oral manifestations of coeliac disease
- Dental enamel hyperplasia
- Pitting or grooving of enamel
- Partial loss of enamel
- Delayed tooth eruption
Describe 5 soft tissue related oral manifestations of coeliac disease
- Aphthous ulceration
- Oral lichen planus
- Angular cheilitis
- Atrophic glossitis
- Bleeding tendency
What is inflammatory bowel disease?
Group of chronic inflammatory conditions primarily affecting the digestive tract
Describe the pathogenesis of inflammatory bowel disease
- Pathogenesis is unclear
- Multi-factorial with immune system, genetics and environmental factors
- One third develop extra-intestinal manifestations
Describe 4 extra oral manifestations of inflammatory bowel disease
- Liver (5%)
- Joints (20%)
- Eye (5%)
- Skin (5%)
Describe the demographics of ulcerative colitis
- Inflammatory condition of the GI tracts (colorectal)
- Second to fourth decade (M=F)
- Smoking is protective
- Eight times more likely to occur if first degree relative affected
Name 4 common presenting symptoms of ulcerative colitis
- Rectal bleeding
- Urgency
- Tenesmus
- Diarrhoea
What are 2 common oral signs of ulcerative colitis?
- Oral ulceration
2. Pyostomatitis vegetans
Describe the clinical signs of oral ulceration during ulcerative colitis
- Most common sign of ulcerative colitis
- Coincides with flair up
- Resemble aphthous ulceration
- Painful for patient
Describe the clinical signs of pyostomatitis vegetans during ulcerative colitis
- Pustules
- Labial attached gingiva
- Males > Females
- Variable sypmtoms
Describe Crohn’s disease
- Chronic granulomatous inflammation to the intestinal wall
- Inappropriate response to intestinal microbes and other environmental factors in genetically susceptible host
- Oral cavity to anal cavity
- Exacerbations followed by periods of remission
Name 5 clinical symptoms of Crohn’s disease
- Abdominal pain
- Diarrhoea
- Rectal blood loss
- Weight loss
- Growth failure in children
Describe the oral manifestation prevalence in Crohn’s disease
- 0.5-37%
- More common in children or patients with perianal involvement
- May be more severe during flair up
Name 6 specific lesions to Crohn’s disease
- Diffuse labial and buccal swelling
- Cobble stoning
- Mucosal tags
- Stag horning
- Deep linear ulcerations
- Mucogingivitis
Describe lip swelling in Crohn’s disease
- Can be diffuse and symmetrical or localised
- May affect both lips
- Can be persistent
- Often chronic fissuring and associated angular cheilitis
Describe cobble stoning in Crohn’s disease
- Fissured and swollen mucosa
- Posterior buccal mucosa and palate
- May be painful
Describe mucosal tags in Crohn’s disease
- Small localised swellings
- Labial and buccal vestibules and retro molar pads
- Asymptomatic
- 75% will show non-caseating granuloma
Describe stag horning in Crohn’s disease
Elevation and prominence of most distal and superficial section of submandibular ducts, terminating in the duct orifices at the midline
Describe linear ulcers in Crohn’s disease
- Deep linear ulceration
- Hyperplastic margins
- Labial and buccal vestibules
Describe mucogingivitis in Crohn’s disease
- Full width gingivitis
- Granular and oedematous appearance
- May be associated ulceration
Name 4 non specific lesions to Crohn’s disease
- Aphthous like ulcers
- Pyostomatitis vegatens
- Angular cheilitis
- Persistent submandibular lymphadenopathy
Describe diabetes mellitus
- Group of metabolic disorders
- Chronic hyperglycaemia
- Insulin resistance, deficiency or both
Name 3 types of diabetes mellitus
- Primary (Type I or Type II)
- Secondary (usually pancreatic injury)
- Drug induced
Name 4 acute presentations of diabetes mellitus
- Thirst
- Polyuria
- Weight loss
- Ketoacidosis
Name 5 subacute presentations of diabetes mellitus
- Older patients
- Delayed healing
- Lack of energy
- Balanitis
- Asymptomatic
Name 6 common oral manifestations of diabetes mellitus
- Sialosis
- Xerostomia
- Caries
- Periodontal disease
- Oral candidosis
- Oral dyaesthesia
Describe the prevalence of hypothyroidism
- Underactivity of thyroid gland
- Common infection
- Primary or secondary
- Increased TSH and reduced T4
- F > M
- Incidence increases with age
Name 4 symptoms of hypothyroidism
- Goitre
- Dysgeusia
- Macroglossia
- Periodontal disease
Describe hyperthyroidism
- Thyroid over activity
- Common
- Many causes
- Increase in T4 and decrease in TSH
Describe the pathogenesis of Addison’s disease
- Primary adrenal insufficiency
- Adrenal glands are damaged
- Cortisol and aldosterone production are affected
Describe 6 common symptoms of Addison’s disease
- Lethargy / Depression
- Anorexia / Weight loss
- Pale brown pigmentation of oral mucosa
- Pressure points
- Skin creases
- Recent scars
