Oral Manifestations of Systemic Disease

Question 1

Classification of oral manifestations of systemic disease

Answer 1

1. Soft tissues/Hard tissues
2. System by system
3. Ulcerative/non-ulcerative

Question 2

Oral mucous membrane colours and what disease they suggest

Answer 2

Pallor: anaemia
Yellowish tint: Jaundince
Brown pigmentation in caucasians: Addison’s disease

Question 3

Which diseases can cause Gingival or mucosal bleeding

Answer 3

1. Purpura present
   a. Acute leukaemia
   b. AIDS
   - May be subcutaneously and submucosally
   - Excessive gingival bleeding may be a feature
2. No purpura present
   a. Disorders of clotting
   - Excessive gingival bleeding may be a feature

Question 4

Which diseases can cause acute gingivitis

Answer 4

1. Acute leukaemia
2. Immunodeficiencies
   a. uncontrolled diabetes
   b. agranulocytosis (blood disorders with low wbc)
   c. AIDS
3. Vitamin deficiencies
   a. scurvy
   b. pellagra (Vit B)

Question 5

Which diseases can cause stomatitis

Answer 5

1. Non-ulcerative
   a. Sjogrens
   b. Candidosis
2. Ulcerative
   a. RAS
   b. Recurrent oral ulcers in Behcets
   c. Secondary to CT/GI/haematological disease
   d. drug reaction

Question 6

Which haematological diseases have oral associations?

Answer 6

• Haematinic deficiency (ferritin, folate, B12)
• Cyclical neutropenia
• Leukaemia

Question 7

Which dermatological diseases have oral associations?

Answer 7

• LP
• MMP, bullus pemphigoid
• Linear IgA disease/ Dermatitis herpetiformis
• Pemphigus
• Erythema multiforme

Question 8

Which GI diseases have oral associations?

Answer 8

1. Coeliac (genetic condition involving hypersensitivity of SI to gliadin (in gluten) - results in atrophy and malabsorption)
   oral presentation: ulceration, glossitis burning mouth, angular stomatitis
2. Ulcerative colitis
3. Crohn’s disease
4. Orofacial granulomatosis
5. sarcoidosis
6. Orofacial granulomatosis
   - Melkersson-Rosenthal syndrome (labial and perioral swelling)
   - Meischer’s Syndrome (labial swelling)
   - Hypersensitivity to food-stuffs or preservatives

Question 9

Commonest cause of cervical lymph node enlargement

Answer 9

• oral sepsis
• may also be first sign of disease of reticuloendothelial system: infective mononucleosis, AIDS, Hodgkin and non-hodgekin lymphoma

Question 10

Which diseases can cause glossitis

Answer 10

1. Anaemia
   - most common identifiable cause
   - often due to iron deficiency
   - latent deficiencies are also important
2. Vitamin deficiencies
   - Riboflavin deficiency and pellagra (vit b)
   - Malabsorption syndrome

Question 11

Which diseases can cause enlarged tongue

Answer 11

1. acromegally
2. amyloidosis (build-up of an abnormal protein called amyloid in organs)
3. granulomatous condition
4. neurofibromatosis (tumour along nerves)
5. hamartoma (benign tumour)
6. neoplasia
7. haemangioma (vascular tumour derived from blood vessel cell types)
8. Lymphangioma (benign malformations of the lymphatic system)

Question 12

What can cause abnormal tooth colour

Answer 12

1. Tetracycline: yellow-brown/grey
2. Fluorosis: opaque white or brown patches
3. severe jaundice: yellow-greenish
4. porphyria: purplish red
5. Dentinogenesis and osteogenesis imperfecta: purplish or brownish but with increases translucency

Question 13

What can affect enamel formation

Answer 13

• Low birth weight
• Febrile illness (illness causing acute fever)
• Systemic disturbance
• Malabsorption/nutritional deficiencies
• Medication

Question 14

What can cause enamel hypoplasia or hypomineralisation

Answer 14

1. congenital syphilis
2. severe childhood fevers
3. severe fluorosis
4. severe rickets
5. hypoparathyroidism

all cause grooving pitting of enamel

Question 15

Which diseases can cause abnormal tooth surface loss

Answer 15

intrinsic acid: GORD and bulimia

Question 16

What are the Multiple effects of AIDS

Answer 16

common: cervical lymphadenopathy, candidosis, kaposi’s sarcoma, hairy leukoplakia

less common: angular chelitis, herpes, recurrent ulcers, severe peridontitis, lymphoma