Oral Manifestations of Systemic Disease Flashcards
What are Gastrointestinal Diseases
what are example of them?
Inflammatory bowel diseases associated with oral findings
▪ Crohn disease
▪ Ulcerative colitis
▪ Pyostomatitis vegetans
▪ Celiac Disease
Crohn Disease
Regional Ileitis
What areas does affect?
What are the symptoms?
What areas does affect?
● Primarily affecting distal small intestine and proximal colon
What are the symptoms?
● Symptoms include abdominal cramping, pain, bloating, diarrhea, and nauseas (similar amongst the GI diseases)
● Patients often have weight loss and malnutrition
● 20% have abrupt onset of symptoms resembling acute appendicitis or bowel perforation
Crohn Disease
Regional Ileitis
When it is diagnosed?
Etiology?
Prevalence?
What are the oral implactions?
When it is diagnosed?
● Usually initially diagnosed in adolescents
Etiology?
● Etiology unknown‐ immunologically mediated?
o Theory of being too clean as a child and having a negative response as we grow older since we’re not used to normal bacteria
Prevalence?
● Prevalence increasing, reason unknown
What are the oral implactions?
●Oral lesions can be first sign of disease
Crohn Disease
Histopathology
● Superficial or deep ulceration with adjacent granulation tissue extending into deep submucosa or below
● A transmural granulomatous inflammation
o Sarcoid‐like, non‐caseating, poorly formed granulomas, in all tissue layers (50‐70% of cases) usually adjacent to blood
vessels or lymphatics
● Transmural inflammation with lymphoid aggregates throughout bowel wall
Crohn Disease
Oral Findings
- Recurrent oral ulcerations can mimic those seen with recurrent aphthous lesions
-
Diffuse or nodular swelling of the oral and perioral tissues
- Can look like epulis fissuratum
-
Deep linear granulomatous‐appearing ulcerations (often in the buccal vestibule area)
- Cobblestone mucosal appearance
- Polypoid tag‐like lesions on vestibular and retromolar mucosa
- Enlargement of lips caused by granulomatous inflammation: orofacial granulomatosis
Crohn Disease
Treatment
- Current strategies aim for deep and long‐lasting remission, with the goal of preventing complications, such as surgery, and blocking disease progression
- Immunosuppressant such as cyclosporine
- In more severe cases;
- *high dose corticosteroids and**
- chemotherapeutics to induce a remission
-
Nutritional supplements (iron, folate)
- Because they are unable to absorb nutrients
- If medical means do not keep patient under control► surgical removal of a portion or all of the intestine
- When intestinal symptoms are under control►oral ulcerations resolve
Which systemic disease manifests like this?
Crohn Disease
- Patients can also get angular cheilitis
- Above the Linear ulceration, can see a flap like structure which is the hyperplastic margin
Which systemic disease has this oral manifestation?
- we see the ulceration and hyperplastic tissue surrounding it.
Which systemic disease has this oral manifestation?
Crohn Disease
Nodular appearance of buccal mucosa
Which systemic disease has this oral manifestation?
Crohn Disease
we see more nodules
Which systemic disease has this oral manifestation?
Crohn Disease
Linear granulomatous ulcerations
But they are not the aphthous ulcerations but the more
linear type
Ulcerative Colitis
- What are the symptoms
- What type of Cancer risk it presents?
What are the symptoms
- A chronic inflammatory disease of the colon (mucosa and submucosa) presenting with diarrhea, rectal bleeding, abdominal pain, weight loss and fever
What type of Cancer risk it presents?
- Increased risk of colon cancer
Ulcerative Colitis
Oral Lesions
● In some cases, patients get recurrent oral ulcerations (can have aphthous‐like lesions)
● Papillary mucosal projections with deep linear ulcers and fissures
● Intraepithelial pustules of the mucosa (pyostomatitis vegetans)
Ulcerative Colitis
Management
● Use of anti‐inflammatory medications
o Sulfasalazine or Prednisone
● If medical means do not succeed► then removal of part or all of colon
How different is Ulcerative Collitis from Crohn Disease?
Unlike Crohn’s, lesions extend in a continuous fashion proximally from the rectum (no skip lesions) and histologically don’t have granulomas
What is the difference between Inflammatory Bowel
Disease IBD & Irritable
Bowel Syndrome IBS
● IBD
o Classified as a disease
o Can cause destructive inflammation and permanent harm to the intestines
o The disease can be seen during diagnostic imaging
o Increased risk for colon cancer
● IBS
o Classified as a syndrome, a group of symptoms
o Dose not cause inflammation; rarely requires hospitalization or surgery
o There is no sign of abnormality during an exam of the colon
▪ Usually because it’s only periodic
o No increased risk form colon cancer or IBD
Pseudomembranous
Ulcerative Colitis
Causes?
Bactrial Overgrowth in the pseduomemberane
(C.difficile Overgrowth)
Causes:
- Clindamycin prolonged use ~2 weeks can cause the C. difficile overgrowth.
- Always warn patients if you prescribe clindamycin about possible side effects and stop usage since do not want them to develop untreatable strains
Pyostomatitis
Vegetans
what is it?
Demographics?
Symptoms onset?
What is it?
- Thought to be an unusual presentation of inflammatory bowel disease, especially ulcerative colitis (sometimes with Crohn’s)\
Demographics
- In only a rare subset of patients
- Typically present before 30 years of age
Symptoms onset
- ~25% of cases seen in absence of GI symptoms
- May see oral symptoms before the GI symptoms
Pyostomatitis
Vegetans
Oral Symptoms
and
Most common sites in the mouth?
Oral Symptoms
● Recurrent oral ulcerations _concurrent with, or prior to GI symptoms_
● Oral mucosa is erythematous and thickened with multiple
cream/yellow‐colored pustulesandsuperficial erosions
● Linear “snail track” oral pustules
Most common sites in the mouth?
● Most common sites include buccal and labial mucosa, soft palate, and ventral tongue
Pyostomatitis
vegetans
Treatment
● Treatment is not well standardized, fairly rare disease and good double blind studies rare
● Can use topical corticosteroids
● Werchniak et al had good results with topical tacrolimus
● Sulfasalazine or Prednisone for GI lesions
● If GI symptoms are under control► oral lesions will resolve
Oral Manifestations of which systemic disease?
Pyostomatitis
Vegetans
Oral Manifestations of which systemic disease?
Pyostomatitis
vegetans
Oral Manifestations of which systemic disease?
Pyostomatitis
vegetans
Snail track
appearance
Celiac (Sprue) Disease
What is it?
Which gene is involved?
Symptoms?
What is it?
● Chronic disease (diffuse enteritis) of the small intestine which improves upon withdrawal of gluten proteins
Which gene is involved?
● >90% express HLA‐B8 histocompatibility antigen
Symptoms?
● Patients present with diarrhea, gas, weight loss, fatigue, impaired nutrient absorption, etc
Patients with Celiac (Sprue) Disease have risk of developing which cancer?
● 10‐15% risk of GI lymphoma
Celiac (Sprue) Disease
Oral Symptoms
● 10‐15% risk of GI lymphoma
● Oral symptoms include aphthous‐like ulceration of mucosa
● Patients can have enamel defects and pitting
Amyloidosis
What is it?
From what does it form?
Seen with what disease?
What is it?
-
Protein deposits in tissue
- Paucicellular eosinophilic deposits amorphous eosinophilic deposit
From what does it form?
- Form fibrillar β‐pleated sheets within the tissue
Seen with what disease?
- multiple myeloma
Amyloidosis
what are its Types and what they are associated with?
- ▪ Primary amyloidosis is associated with multiple myeloma
- Reactive systemic amyloidosis
- Hemodialysis associated amyloidosis kidney dysfunction
- Hereditary amyloidosis (Familial Mediterranean Fever), present with polyneuropathies, cardiac arrhythmias, renal failure, CHF
- Localized dermal amyloidosis
Primary amyloidosis is associated with which cancer?
multiple myeloma
Hemodialysis associated amyloidosis leads to ——
kidney dysfunction
Amyloidosis
Organ Limited
Clinically
- Rare in oral cavity
- Amyloid nodule, asymptomatic submucosal deposit
- Not associated with systemic symptoms
Primary or Muliple Myeloma associated Amyloidosis
Systemic
Demographics & Clinical presentations
- Older adults > 65yrs
- Male predilection
- Amyloid deposits lead to macroglossia, carpal tunnel syndrome, hepatomegaly, dry mouth
- Skin lesions: Waxy papules and plaques, smooth surface (eyelid area, retroauricular, neck, lips), orangy, red appearance
Secondary Amyloidosis
systemic
Etiology & Effects
- Due to chronic inflammatory process
- *(osteomyelitis, TB,** sarcoidosis)
- Affects liver, kidney, spleen, adrenals but not heart
- can affect multiple organs, heart is usually spared
Hemodialysis associated Amyloidosis
Etiology & Effects
o Accumulation of normal protein (beta‐2 microglobulin) in plasma
_o Deposits in bones and joint_s
o Carpal tunnel syndrome, cervical spine pain
o Tongue deposits can have macroglossia
Amyloidosis
Clinical Presentations
-
Deposition of an extracellular proteinaceous material‐often immunoglobulins
- all types have common feature of a β‐pleated sheet molecular configuration
-
Macroglossia
- can be massive and exhibit dental indentations (crenation) with yellowish peripheral nodules
- Gingiva: usually normal in color, but may be bluish, spongy and enlarged
- Xerostomia if deposits in salivary glands
- Mucosal petechiae can be seen
Oral manifestation of which Systemic Disease?
Amyloidosis
Nodular “waxy” depositions in skin
deposition on the eyelid
Which systemic disease has this oral manifestation?
Amyloidosis
orange, red, yellow tinge
Which systemic disease has this oral manifestation?
Amyloidosis
Macroglossis and crenation of tongue (indentation near the teeth area)
skin deposits on the comissure,
Which systemic disease has this oral manifestation?
Amyloidosis
macroglossia
Which systemic disease has this oral manifestation?
Amyloidosis
Submucosal amyloid deposit
Which systemic disease has this oral manifestation?
Amyloidosis
Amyloid deposition on the tongue is amyloid, you have papule and nodule like area, can see the crenation of the tooth
Which systemic disease has this oral manifestation?
Amyloidosis
Amyloid deposition with ulceration and petechiae
Which systemic disease has these oral manifestations?
Amyloidosis
▪ different color compared to normal tongue with amyloid
Amyloidosis
Mangement
- Medical work‐up to determine type of amyloidosis
- Treat underlying disease when possible
- No treatment available for most types
- Chemo drugs (Colchicine, Prednisone, Melphalan, Thalidomide, Cyclophosphamide) for multiple myeloma
- Serum electrophoresis – monoclonal gammopathy very complicated and time consuming treatment
- Renal transplant for dialysis‐associated type
- Death due to cardiac failure, arrhythmias or renal failure is not uncommon within a few year of dx
Diabetes Mellitus
Endocrine Disease
- a group of metabolic disorders with one common manifestation: hyperglycemia
- Basic problem is either a decreased production of insulin or tissue resistance to insulin
Diabetes Mellitus
Pathophysiology
▪ Insulin is hormone produced by beta cells of the pancreatic islets of Langerhans
▪ It is required for the uptake of glucose by body cells
▪ Insulin binds specific receptors which trigger the intracellular events necessary for glucose uptake
Diabetes Mellitus
Types
Type 1
Type 2
Diabetes Mellitus
Type I
Definition
Demographics
Symptoms
Etiology
Definition
insulin‐dependent diabetes mellitus (IDDM)
Demographics
5‐10% of cases
Juvenile onset (avg age 14)
Symptoms
- Severe absolute lack of insulin
- Hyperglycemia and ketoacidosis
- Blood glucose levels of 200‐400 mg/dl (70‐120 normal)
- Ketoacidosis from using protein and fat for energy instead of glucose body can’t use glucose
- Thin body habitus
Etiology
- Autoimmune disease
- Thought to be possible viral infection as trigger to Islet cell antibody destruction of beta cells
Diabetes Mellitus
Type II
Definition
Demographics
Symptoms
Etiology
Definition
- non‐insulin‐dependent diabetes mellitus (NIDDM)
Demographics
- About 90% of cases
- Onset in older, obese adults (80‐90%); ketoacidosis is rare
Symptoms
- _Patients produce some insuli_n, can typically be treated with oral medication
- “insulin resistance”‐ insulin levels appear WNL or elevated
Etiology
- Decreased number of insulin receptors or defective receptors
- Genetic abnormalities, multifactorial
- Growing percent of the US population as well as around the world
Diabetes Mellitus
Complications
▪ Decreased neutrophil chemotaxis ►do not fight off infections as well as
you should
▪ Peripheral vascular disease►microangiopathy
o Results in ischemia: kidney failure, gangrenous complications of lower limbs, retinal involvement leading to blindness
o Amputations, CVA or MI
o Ketoacidosis may lead to diabetic coma
Diabetes Mellitus
Oral Findings
Most often associated with Type I but may be seen with Type II
- Periodontal disease‐ more frequent occurrence, more rapid progression
- Poor healing post oral surgery/extractions
- Enlargement and erythema of the attached gingiva
-
Increased risk of infections
- Candidiasis
- Xerostomia‐ 1/3 of pts complain of dryness
- Diabetic Sialadenosis‐ both type I and type II
- Mucormycosis‐ in uncontrolled disease and the tissue becomes necrotic because it is not getting any blood supply
-
Dental Carieso Benign migratory glossitis
- Increased prevalence in type I
Diabetes Mellitus
TYPE I
Management
- Insulin injections
-
Insulin shock‐ if blood glucose falls below 40 mg/dl
- Treat with dextrose
Diabetes Mellitus
TYPE II
Management
- Dietary modification and weight loss
-
Oral hypoglycemic agents
- ex. tolbutamide, glyburide, metformin
- Drugs may cause a lichenoid drug reaction
Oral Manifestation of which systemic disease
Diabetes Mellitus
Gingivitis = puffy red papillae here between the
central and lateral incisors
Oral Manifestation of which systemic disease ?
Diabetes mellitus
Anterior papillae are very puffy and red and fill of pus
Posterior gingiva are very
hyperplastic
Oral Manifestation of which systemic disease ?
Hyperplastic gingiva
Oral Manifestation of which systemic disease ?
Diabetes Mellitus
Sialadenosis
Oral Manifestation of which systemic disease ?
Diabetes Mellitus
diabetic patient who
developed Mucormycosis
Notice it is causing necrosis in the palate
Which systemic disease has this oral manifestation?
Lichenoid mucositis looks like lichen
planus
-same reticular white pattern, but there are
areas of erosion and some ulceration as
well
-some diabetic medications can lead to this
Hyperthyroidism
what is its most common form?
Graves’ Disease is the most common form
o An autoimmune disease attacks thyroid (TSH receptor)
o Leads to elevated release of thyroxine
o Most often a diffuse thyroid enlargement (goiter)
Benign and malignant tumors of thyroid and pituitary gland can cause which systemic disease
hyperthyroidism
In Hyperthyroidism, what happens to
T4 (thyroxine) and TSH values
- Serum T4 (thyroxine) is elevated
and
- TSH is decreased
Hyperthyroidism
Demographics
▪ 5‐10X more common in females ‐ 2% of women
▪ 3rd ‐ 4th decade of life
Hyperthyroidism
What patients might complain of?
What are the symptoms?
What patients might complain of?
- nervousness
- heart palpitations
- heat intolerance
- muscle weakness
- emotionally labile
What are the symptoms?
- weight loss, excessive perspiration, tachycardia,
tremors, eyelid retraction and exophthalmos
- 20‐40% have ocular involvement
o Early in the disease‐ characteristic stare with eyelid retraction and lid lag
o Exophthalmos or proptosis
▪ Oral findings in children can include early eruption of teeth
Hyperthyroidism
Treatment
- Treatment includes:
- Surgery – complete or partial removal of thyroid gland
-
Medications
- Propylthiouracil and methimazole block normal use of iodine by thyroid gland
- Radioactive iodine 131I
- Treatment often results in hypothyroidism
Which systemic disease has this oral manifestation?
Hyperthyroidism
- enlargement of the neck
- characteristic stare
Hypothyroidism
What happens in Hypothyroidism?
What it is called in children & adults?
How it is diagnosed?
What happens in Hypothyroidism?
- Decreased levels of thyroid hormone
What it is called in children & adults?
- cretinism in children
- myxedema in adults
How it is diagnosed?
- Diagnosed by measuring T4 (free thyroxine) in serum
Hypothyroidism
Primary and secondary etiologies and T4,TSH profile?
▪ Primary Hypothyroidism
‐ due to abnormality in thyroid gland
o T4 low, TSH elevated
▪ Secondary Hypothyroidism (less common)
‐ pituitary gland doesn’t produce adequate
amounts of TSH
o T4 low, TSH low or borderline
Hashimoto’s thyroiditis or thyroid surgery are main causes in adults of which systemic disease?
Hypothyroidism
Hypothyroidism
Symptoms
Oral findings
Symptoms
- Symptoms include lethargy, dry skin, thinning hair, swelling (edema) of face and extremities, huskiness of voice, weakness and fatigue
- ▪ Infants have failure to thrive
Symptoms
o Thickened lips and macroglossia due to accumulation of glycosaminoglycans (GAGs)
o In children can see failure of tooth eruption even though teeth have normal development (enamel pitting can be seen)
Hypothyroidism
Treatment
▪ Treatment is thyroid hormone replacement
▪ Prognosis is generally good
▪ If children are not treated in a timely fashion ► permanent CNS damage can occur (mental retardation)
Which systemic disease has this oral manifestation?
hypothyroidism
woman who had
hypothyroidism, lips are thickened, thick creases in the face
Which systemic disease has this oral manifestation?
hypothyroidism,
in child, still has
deciduous teeth even though its an older child
Radiographically we see the teeth have not erupted in the oral cavity
Which systemic disease has this oral manifestation?
Hypothyroidism
Macroglossia and crenation (scalloping)
of the lateral tongue
Before and after tx of which systemic disease?
hypothyroidism
Hyperparathyroidism
Can be Primary or Secondary
- Reduced amounts of PTH
- Parathormone normally stimulates osteoclasts in bone and resorption in kidney, to bring serum levels of calcium back to normal with decreased parathyroid function, serum calcium levels drop → hypocalcemia
- Lab findings ‐ PTH ↓, calcium ↓, phosphate↑, and normal renal function
- Postive Chvostek’s sign ( sign of low Calcium)
Females 2 to 4 times more than males
Primary Hyperparathyroidism
Charcterstics
o Uncontrolled PTH production
o 80‐90% caused by parathyroid adenoma
o ~15% caused by hyperplasia
o ~ 2% caused by parathyroid carcinoma
An Oral Manifestaion of which systemic disease?
Hyperparathyroidism
in young children
Which systemic disease has this oral manifestation?
Pseudohypoparathyroidism
pulp chambers are very
elongated
Which systemic disease has this oral manifestation?
Pseudohypoparathyroidism
issues with eruption, no
pulp stones present
What systemic disease causes this oral symptoms?
Hereditary
Hypophosphatemia/vitamin D‐resistant rickets
teeth look fairly
normal, have a draining abscess with ulcers and perilous
What systemic disease causes this oral symptoms?
Hereditary
Hypophosphatemia/vitamin D‐resistant rickets
teeth look fairly
normal, have a draining abscess with ulcers and perilous
Hereditary
Hypophosphatemia
Histology
Enlarged pulp horns
o Can extend up to DEJ
Abnormal globular dentin
o Dentin may exhibit clefting
Enamel clefts
Bacteria noted in enamel, dentin and pulp
o Pulpal involvement leads to necrosis and development of the periapical pathology
Which systemic disease has these clinical manifestations?
Acromegaly
Which systemic disease manfiest like this?
Addison’s Disease
Which systemic disease manfiest like this?
Addison’s Disease
Which systemic disease is associated with this symptom?
Pellagra
Deficience in Vitamine B3 (Niacin)
Pellagra
Deficience in Vitamine B3 (Niacin)
Dermititis of the skin
Which systemic disease manifests like this?
Pellagra
Deficience in Vitamine B3 (Niacin)
erythema of the tongue
Plummer‐Vinson
Syndrome
Why it is a concern?
Why it is a concern?
Premalignant process
o ↑ incidence of oral and esophageal SCCa
Which systemic diseaswe associated with these oral manifestations?
PLUMMER‐VINSON
SYNDROME
denuded tongue
and angular chelitis
Which systemic diseaswe associated with these oral manifestations?
PLUMMER‐VINSON
SYNDROME
Angular chelitis (top) hard to get rid of them
Atrophic Glossitis (bottom) red beefy tongue
How blood looks with
Top photo: in Iron Deficiency Anemia, Plummer‐Vinson Syndrome, small area that is pale in the center
Bottom photo : normal smear, center is not pale
Smear blood of Pernicious Anemia vs normal blood smear
not biconcave
Which systemic disease manifests like this?
Pernicious Anemia
glossitis, denuded papillae
This is a before and after of which systemic disease?
Pernicious Anemia
denuded tongue and then the papillae is back again after the treatment. You have to get injections for the rest of your life
Which systemic disease has this oral manifestation?
Uremic Stomatitis
Before and after treatment of which systemic disease?
Uremic Stomatitis
Before and
After Tx with Dialysis
changes on ventral and lateral side
of the tongue, better outcome after dialysis
Which systemic disease has these oral manifestations?
Reiter’s Syndrome (Reactive arthritis)
This not actually a geogrpahic tongue!
Which systemic disease has these oral manifestations?
Reiter’s Syndrome (Reactive arthritis)
Top: erythema on the palate and
areas of ulceration
Bottom: classic look of geographic
tongue, but it is not geo tongue. They are symptoms of Reiter’s
Infective endocarditis
▪ Janeway lesions
o Seen on palms of hands and soles of feet (tiny micro emboli that are causing lesions on the hands and feet)
▪ Erythematous macule or petechiae
▪ Painless
▪ Septic micro emboli
Which systemic disease has these clinical manifestations
Infective Endocardiatios
Janeway lesions
These are Septic Emboli
Which systemic disease is this?
Hyperparathyroidism
Here we see we see
- a granular appearance of the max and mand bone everywhere, it is not localized.
- There is a loss of bone density and the loss of definition of cortical bone.
- Here we see a loss of definition of lamina dura as well because it is now granular, and is not as clear.
Which systemic disease shows radiographically like this ?
Hyperparathyroidism; this is the brown tumor which is sometimes well or ill defined, multi or unilocular radiolucency with granular septation.
If you have a patient that is younger than 15-20 years old that has a central giant cell granuloma ► you have to check that patient for hyperparathyroidism, because it could be a brown tumor.
Which systemic disease shows radiographically like this ?
This is another medical CT scan. You see the granular appearance of
the maxilla, skull, and well-defined multilocular radiolucency with
granulation. We call this a brown tumor because it is associated with
hyperparathyroidism.
( systemic endocrine diseases)
Which systemic disease shows radiographically like this ?
Hyperparathyroidism
On our intraoral radiographs, we see loss of definition of lamina dura because the bone now has a granular appearance which extends to the lamina dura.
The teeth are usually normal, but there is a loss of lamina
dura around the teeth. These teeth are not mobile.
Which systemic disease shows radiographically like this?
a medical CT scan of a patient with secondary hyperparathyroidism.
We see a lack of cortical bone – no normal cortical bone. Inside the skull
we have a granular appearance, with radiolucent and radiopaque dots, we call this a salt and pepper dots.
This is why we call this a salt and pepper appearance, there is no normal cortical bone.
( systemic endocrine diseases)
Which systemic disease shows radiographically like this?
we have 2 Pas of patients
with pseudohypoparathyroidism.
- hypoplasia of enamel, tooth material
- hypoplastic tooth bud ( hypoplastic means arrested development)
- delayed eruption,
- external root resorption.
Which systemic disease shows radiographically like this?
Acromegaly (Hyperpituitarism)
- enlargement of the mandibular bone with a high degree of enlargement
- a class III appearance
- enlargement of sella tursica because of the pituitary gland enlargement
Which systemic disease manifests radiographically like this?
Dwarfism
- hypopituitarism*
- We see* multiple dental anomalies: hypodontia, radicular fusion, fused roots of left lateral incisor and left canine and impacted permanent teeth.
- (from google)*
Which systemic disease shows radiographically like this?
Osteoporosis
- reduction in bone density,
- larger bone marrow spaces.
We need more tests to confirm osteoporosis besides dental radiographs.
Which systemic disease shows radiographically like this?
medical CT scan with a patient with osteopetrosis- very dense. Not a
nice definition of the cortical bone. We see decreased in size of skull
foramina.
Which systemic disease shows radiographically like this?
pt with Osteopetrosis
we see
Hypovascular bones so they are more prone to osteomyelitis. This is a sign of sequestrum which is a sign of osteomyelitis.
pt with Osteopetrosis
- Generalized increase in bone density, increased trabeculation, loss of large bone marrow spaces.
- These patients are more prone to osteomyelitis because they are Hypovascular.
- We have to be careful in extractions because they don’t have the same vascularity as other healthy patients have.
- We see an onion skin appearance by the white arrow.
Which systemic disease has this radiographic manifestation?
Ricket / Osteomalacia
hyperplasia or thinning of mineralization of teeth. We
can see hyperplasia of enamel in patients.
Which systemic disease manifest radiographically like this?
Renal
Osteodystrophy 1
Presentation is variable. Sometimes you see denser or granular
appearance of bone. You see increase here
but you sometimes will also see loss of definition of lamina dura, sometimes a sclerotic appearance
and trabeculation.
Which systemic disease manifest radiographically like this?
Renal
Osteodystrophy 2
sometimes you see:
- increase in bone density
- loss of definition of lamina
- dura and cortical bone
Which systemic disease manifests radiographically like this?
Hypophosphatasia
Which systemic disease manifests radiographically like this?
large root canal structures, large root chambers, premature loss of
teeth = hypophosphatasia.
Which systemic disease manifests radiographically like this?
Hypophosphatemia
- Periapical lesions with radiolucency but no caries on the crown.
- There is loss of definition of cortical bone.
- On the teeth, you have:
- large pulp chambers
- hypoplasia of enamel and dentin
- periodontal and periapical lesions.
Which systemic disease manifests radiographically like this?
Progressive Systemic
Sclerosis
(scleroderma)
sharp areas of resorption in the bones near muscles attached to the
angle of the mandible= masseter and medial pterygoid. You see
resorption at the coronoid process at the attachment of the temporal
bone as well.
Which Systemic disease manifests radiographically like this?
Progressive Systemic
Sclerosis
(scleroderma)
- presence of widening of the PDL space everywhere around the root of the tooth.
Which systemic disease mainfest radiographically like this?
On a sickle cell anemia patient, you see:
- loss of this cortical bone area
- the hair-on-end appearance on the skull
Which systemic disease mainfest radiographically like this?
Sickel Cell Anemia
enlargement of bone marrow spaces, less trabeculation, more
osteoporotic bone. You see periapical pathology associated with teeth
with no obvious reason. You see the radioluscencies around the apex of
the mandibular teeth.
Which systemic disease mainfest radiographically like this?
Thalassemia
- osteopenic bone (loss bone mass and bones get weaker)
- radiolucent appearance of bone
- thinning of cortical bone around the mandible and maxilla.
- Usually there is hypoplasia of the paranasal sinuses.
