Oral Manifestations (2) Flashcards
Describe 3 brackets of haematological conditions
- White blood cell disorders
- Red blood cell disorders
- Platelet disorders
Name 2 types of white blood cell disorders
- Decreased production and function of WBC
2. Neoplasms
Name 2 types of red blood cell disorders
- Polycythaemia
2. Anaemia
Name a type of platelet disorders
Thrombocytopaenia
What is leukopenia?
Reduced number of white blood cells
What is neutropenia?
Absolute reduction in circulating neutrophils
Describe cyclic neutropenia
- Rare
- May be inherited or spontaneous
- Episodes of reduced neutrophil production
Describe 5 symptoms of cyclic neutropenia
- Fever
- Malaise
- Cervical lymphadenopathy
- Infections
- Oral ulceration
Name 2 types of white blood cell neoplasms
- Leukaemia
2. Lymphoma
Name 4 types of leukaemia
- Acute lymphocytic leukaemia
- Chronic lymphocytic leukaemia
- Acute myeloid leukaemia
- Chronic myeloid leukaemia
Name 2 types of lymphoma
- Hodgkin lymphoma
2. Non-Hodgkin lymphoma
Describe leukaemia
- Malignant neoplasms of haemopoietic stem cells
- Aetiology linked to radiation, chemotherapy and viral issues
- Uncommon (1/10,000)
Describe 5 symptoms of leukaemia
- Gingival enlargement
- Bleeding
- Petechial
- Oral ulceration
- Lymphadenopathy
Describe lymphomas
- Neoplastic transformations of normal B and T cells in lymphoid tissue
- More common than leukaemia
- Painless rubbery lymph node enlargement
Describe the constitutional symptoms of lymphoma
- Headache
- Pain
- Dyspnoea
- Malaise
Describe non-constitutional symptoms of lymphoma
- Lymph node enlargement
- Soft tissue swellings
- Radiolucency
- Alveolar bone loss and swelling
What is anaemia?
When haemoglobin level is below normally accepted range
Describe 2 common symptoms of anaemia
- Fatigue
2. Shortness of breath on exertion
Name 5 types of anaemia
- Pernicious
- Aplastic
- Thalassaemia
- Megaloblastic
- iron deficiency
Describe the diagnosis of anaemia
Diagnosed on mean cell volume into:
Normocytic anaemia
Macrocytic anaemia
Microcytic anaemia
Describe 4 oral symptoms of anaemia
- Mucosal pallor
- Atrophic glossitis
- Candidiasis
- Recurrent oral ulceration
What is thrombocytopaenia?
Reduced platelet numbers, can either be primary (immune thrombocytopaenia) or secondary (e.g destruction of platelets in kidney)
Name 4 characteristic symptoms of thrombocytopaenia
- Epistaxis
- Gingival bleeding
- Skin manifestations
- Excessive bleeding following surgery
Name 6 oral signs of renal disease
- Bleeding
- Dry mouth
- Halitosis (smells of nitrogen)
- Amyloidosis
- Dysguesia (distored taste)
- Uremic stomatitis
Describe uremic stomatitis
- Rare
- Found in undiagnosed or untreated chronic renal failure
- Painful plaques
What is lichen planus?
- Chronic inflammatory autoimmune mucocutaneous disease
- Affects stratified squamous epithelium
- Lesions on palate, FOM and upper lip uncommon
Describe the demographics of lichen planus
- Affects 1-2% population
- Mainly 5th-6th decade
- 2F:1M
- Oral disease lifelong
- 1-3% risk of malignant transformation
Describe reticular lichen planus
- Most common
- White network of overlapping and connecting lines, papules or plaques
- Rarely symptomatic
- 10% gingival involvement
Describe erosive lichen planus
- Ulceration within areas of atrophy or hyperkeratosis
- Variable degrees of soreness
Describe atrophic lichen planus
- Erythematous lesions
- Desquamative gingivitis
- Most common type of gingival lichen planus
Name 2 important sub-endothelial vesiculobullous disorders
- Erythema Multiforme
Name an important intra-endothelial vesiculobullous disorder
Pemphigus
Describe erythema multiforme
- Immune mediated mucocutaneous condition
- Acute, self-limiting and recurrent
- Uncommon (<1%)
- Young adults in 20-30 age group
Describe the symptoms of erythema multiforme
- Lips which swell, bleed, crack and crust
- Irregular superficial ulceration
- Target lesions
Describe mucous membrane pemphigoid
- Immune mediated sub-epithelial blistering disease
- Full thickness epithelium blister forms painful erosions
- Uncommon (mainly older women)
Describe the oral mucosa found in a person suffering from mucous membrane pemphigoid
- Blisters (rupture, irregular, inflammatory halo)
- Extensive desquamative gingivitis
- Affects: Gingiva > Palate > Buccal mucosa > Tongue
- Bleeding, pain, dysphagia
- Scarring is rare
Describe 4 ways mucous membrane pemphigoid affects the ocular region
- Conjunctiva
- Entropion with trichiasis
- Blindness
- Symplepharon
Describe pemphigus vulgaris
- Potentially life-threatening chronic autoimmune disease
- Characterised by intra-epithelial blistering of stratified squamous epithelium
- Most common but also most aggressive
Describe 5 clinical features of pemphigus vulgaris
- Fragile bullae (rupture, ill-defined erosions and ulcers)
- Gingival, buccal and palatal lesions
- Superficial and painful
- Slow to heal
- No scarring
Describe Behcets disease
- Chronic, relapsing multisystem inflammatory disease
- Unknown aetiology
- Prevalent along the ancient “Silk Route”
Describe 5 clinical manifestations of Bahcet’s disease
- Mucocutanous lesions
- Ocular
- GI
- Pulmonary
- Neurological
Describe rheumatoid arthritis
- Chronic system autoimmune disorder
- Affects around 1% of population
- Age of onset 30-50 years
- Causes symmetrical polyarthritis
Describe 5 oral manifestations of rheumatoid arthritis
- Xerostomia
- Ulceration
- Glossitis
- Angular cheilitis
- TMJ involvement (pain, tenderness, swelling)
Describe systemic lupus erythematosus
- Multi-system autoimmune disorder
- 2nd-5th decade
- 10F:M
- Afro-Caribbean
- Type III hypersensitivity reaction
Describe 5 common signs of SLE
- Musculoskeletal signs
- Hair loss
- Oral involvement
- Renal disease
- Sun induced skin rashes
Describe 6 oral manifestations of SLE
- Maculopapular rash
- Desquamative gingivitis
- Oral ulceration
- Glossitis
- Angular cheilitis
- Trigeminal neuropathy
Describe scleroderma
- Chronic autoimmune disorder
- 3rd-5th decade
- 4F:M
Describe the pathogenesis of scleroderma
- Overactive fibroblasts
- Increased deposition of collagen
- May be localised, limited diffuse (CREST) or diffuse
Describe orofacial features of scleroderma
- Wide eyed appearance
- Smooth, taut, mask-like facies
- Facial asymmetry
- PDL widening
- Thinning of lips
Describe Sjogren’s Syndrome
- Chronic systemic autoimmune disorder involving damage to exocrine glands
- Primary or secondary forms (RA, SLE and Scleroderma)
Describe 6 symptoms of Sjogren’s Syndrome
- Xerostomia
- Xerophthalmia
- Soreness of oral mucosa
- Dysphagia
- Fatigue
- Fractures / Carious teeth
