Oral manifestations of systemic disease Flashcards
What is examined in the 8 steps when screening for oral cancer?
- gingiva and mucosa
- lip
- buccal mucosa and posterior gingiva
- vestibule, anterior gingiva, mucosa
- hard palate
- tonsillar area, soft palate
- ventral surface of tongue and floor of mouth
- lateral border of tongue
What colour may the teeth be if they were affected by tetracycline during odontogenesis?
Yellow to brown or grey
What may you see if a patient suffers with fluorosis?
Opaque white or brown patches
Rough pitting
What would the teeth look like due to severe long term or childhood jaundice?
Yellow or greenish
How would you recognise if a patient has congenital syphilis?
Dental hypoplasia - notched and peg-shaped permanent incisors
Molars may also be deformed (moon’s molars) - this is where crowns are widest at the base and narrowest at the cusps, no grooves and crown surface is smooth
What may you notice that would indicate that untreated congenital syphilis in a patient?
Sabre shins (anterior bowing of tibia)
Stamping gait
What may indicate that your patient suffered with severe childhood fevers?
Horizontal grooves or pits (particularly of incisors)
Give examples of 2 countries where people may suffer from severe fluorosis du to very high fluoride?
Yemen
Sudan
How does severe rickets affect teeth?
Grooving or pitting of enamel
What may you see if a patient suffered from hypoparathyroidism?
Ectodermal defects (grooving/pitting of enamel)
Why may mucosal tissues look pale (pallor)?
Anaemia
What may be the cause of pigmentation on the oral mucosa?
Ethnicity (racial pigmentation)
Addison’s (adrenal insufficiency, body doesn’t produce enough of certain hormones e.g. cortisol, aldosterone)
What would a blue tint suggest?
Cyanosis - when tissues are not getting enough oxygen
What would a yellowish tint of oral mucosa suggest?
Jaundice
What may blue/brown gingival margins indicate?
Heavy metals - lead, bismuth
What may blue/brown patches in mouth indicate?
Melanoma
Amalgam tattoo
Silver sulphide - old silver point RCT
What is purpura?
It is the haemorrhaging of small blood vessels, causing a discolouration of the mucosa or skin
What may purpura of the gingiva or mucosa be a sign of? (Name disease examples)
- Acute leukaemia
- HIV/AIDS
- Steroid treatment (iatrogenic)
- Myelodysplasias (rare blood cancers lacking healthy blood cells e.g. low platelets)
What may be an additional feature if you are seeing purpura in the gingiva or mucosa?
Excessive gingival bleeding
What may you see (or not see) if your patient has a clotting disorder? What is an example of this?
Excessive gingival bleeding
Anticoagulant excess
Purpura NOT present
Haemophilia A most common cause (also haemophilia B and Von Willebrand’s)
Name 3 examples of what illness/condition may cause acute gingivitis
Acute leukaemia
Immunodeficiencies
AIDs
Agranulocytosis (blood disorder where pt lacks neutrophils)
Uncontrolled diabetes
Vitamin Deficiencies (Scurvy- Vit C, Pellagra- Vit B3)
What medications are often the main cause of gingival hyperplasia?
What disease should you also consider?
Nifedipine (treats hypertension)
Cyclosporin (immunosuppressant)
Phenytoin (anti-seizure)
Also consider leukaemia
Name 3 systemic disease that may present a stomatitis in the mouth
Measles Chickenpox Syphilis Herpes Zoster Herpes simplex Tuberculosis (painful, hiding ulcer) Actinomycoses (following removal of wisdom teeth) Crohn's disease Granulomatosis
What may be the cause behind aphthous stomatitis?
What is aphthous stomatitis?
Iron, vit B12 or folic acid deficiency
Recurrence of benign and non-contagious mouth ulcers
What may white patches/keratosis be a sign of?
Lichen planus Lupus Immunosuppression Renal failure Tertiary syphilis
What is glossitis?
It is where the tongue becomes swollen and inflamed
What can be the cause of glossitis (2)?
- Anaemia: most common identifiable cause, most frequently due to iron deficiency (iron stored in filliform papillae)
- Vitamin deficiencies: riboflavin deficiency and pellagra (rare), malabsorption syndrome
What 4 effects could arise from HIV/AIDS or any immunosuppression?
Cervical lymphadenopathy
Candidosis
Kaposi’s sarcoma (cancer that forms in lining of blood and lymph vessels)
Hairy leucoplakia (triggered by EBV - causes white patches on tongue)
Give 3 examples of less common effects from HIV/AIDS or immunosuppression
Angular chelitis Herpes simplex Herpes zoster Rapdily progressive perio Lymphoma
Oral cancer frequently has NO symptoms - but give 5 examples of symptoms when they do occur
- sore lump of ulcer that does not heal after 2 weeks
- lump in neck - painless, but hard and growing
- white or red patch
- Unusual bleeding, pain or numbness in mouth
- Oral pain that does not go away or feeling that something is caught in throat
- Difficulty or pain with chewing or swallowing (dysphagia)
- Tongue mobility/stiffness problems
- Difficulty with jaw opening
- Jaw swelling - may present as poor denture fit
- Rapid tooth loosening - (too fast for perio?)
- Bad breath
- Sensory and motor loss of the face (5&7 involved)
- ## Abnormal taste in mouth
Give 3 examples of diseases which may present as changes in the jaws
Paget’s disease
Widespread metastases
Hyperparathyroidism (this in turn causes hypercalcaemia)
What makes up the Gardner triad?
- SOFT TISSUE TUMOURS& ABNORMALITIES
- e.g. lipomas, cysts - HARD TISSUE ABNORMALITIES
- e.g. osteomas, odontomas - MULTIPLE INTESTINAL POLYPOSIS
- high potential for malignant degeneration
What illness is the most common cause for enlargement of cervical lymph nodes?
What are other possible illnesses that cause this?
Oral sepsis
Glandular fever Hodgkin's disease Lymphoma (NH) Lymphocytic leukaemia HIV/AIDS
What 4 conditions/illnesses may you notice by looking at your patient’s hands?
Rheumatoid arthritis (xerostomia, Sjogren’s syndrome)
Clubbing (liver or heart disease)
CNS - Parkinson’s (tremor)
Liver disease (liver palms, tremor
