Oral Manifestations of Systemic Disease Flashcards
What is Coeliac disease and which area of the body does it effect?
Permanant intolerance to GLIADIN - wheat protein
Lifelong inflammatory condition (malabsorption)
Affects the small intestine
List 4 oral manifestations of Coeliac Disease:
- Glossitis
- Angular Cheilitis
- RAS (oral ulcerations - inflammation)
- Enamel hypoplasia (mottling), particularly lower incisors
What is Crohn’s Disease and some symptoms?
Crohn’s Disease is an idiopathic disorder that can involve the entire GI tract.
Some Symptoms include diarrhoea, constipation and abdominal pain.
-Anal fistulas specific to Crohn’s
List 4 oral manifestation of Crohn’s Disease:
- Mucosal tags or ‘cobble stoning’
- Lips fissures
- Persistent lymphadenopathy - enlarged lymph glands
- Angular Cheilitis
What is Ulcerative colitis?
What is the most common oral manifestation of ulcerative colitis?
It is an inflammatory condition, similar to Crohn’s disease, that effects the colon.
Angular cheilitis
List 3 symptoms of Gastro-oesophageal reflux disease (GORD):
- Heartburn
- Epigastric pain - stomach pain
- Regurgitation
What is the most common oral manifestation of GORD:
- Dental erosion on palatal area of teeth
What does the term ‘petechiae’ describe?
What do the terms ‘purpura’ and ‘ecchymoses’ describe?
What do all these terms have in common in terms of blanching?
Petechiae - Smaller lesions
Purpura and Ecchymoses - Larger lesions
When pressed, none of these will blanch
- What is the indication of intra-oral jaundice?
- What indications are there of impaired homeostasis in the oral cavity?
- Bilirubin in the submucosa - soft palate and sublingual mucosa regions
- Impaired haemostasis - excessive gingival bleeding from minor trauma
What is anaemia?
Anaemia - reduction in the level of haemoglobin and/or decreased number of erythrocytes
What are oesophageal webs?
Oesophageal webs - membranes of normal oesophageal tissue that partially obstruct the oesophagus
List 5 oral manifestations of Anaemia:
- Glossitis
- Smooth depapillated tongue - iron deficiency
- Raw beefy tongue - Vitamin B12 and folate deficiencies)
- Oral candidosis - including angular cheilitis
- Plummer-Vinson Syndrome - dysphasia (swallowing difficulties) due to oesophageal webs and iron deficiency
What is Acute Leukaemia and where does it typically originate?
Malignant neoplasm of blood-forming tissue - abnormal proliferation of leukocytes
Usually originates in bone marrow
List 4 oral manifestations of Acute Leukaemia:
- Gingival swelling - leukemic cells
- Leukemic deposits - tumour-like masses of leukemic cells
- Oral petechiae and purpura
- Oral ulceration - haematinic deficiencies
What is purpura typically the result of?
List 2 oral manifestions of purpura:
Purpura is result of platelet disorder
Oral manifestations:
1. Petechial haemorrhages
2. Blood-filled blisters on the oral mucosa
List 5 causes of platelet disorders:
- Idiopathic thrombocytopenia
- SLE - connective tissue disease
- Acute leukaemia
- Drug-associated causes
- HIV
What is idiopathic thrombcytopenia?
It is a chronic myeloproliferative disorder - excessive production of platelets (thrombocytes).
What drugs should be avoided for patient with bleeding disorders?
Aspirin and any anti-inflammatory analgesics
What is the role of the Von Willebrand factor (vWF) in the clotting cascade?
Which factor in the clotting factors is vWF part of?
This helps strengthen links between platelets and collagen when a blood vessel in damaged
vWF is part of factor VIII complex - binds to factor VIII which is a key clotting protein
What triggers the intrinsic pathway?
Intrinsic = injury pathway
It is activated by damage directly to blood vessel and the exposure of collagen to the circulating platelets within the blood.
What is the role of the extrinsic pathway?
Extrinsic = everything pathway
It is activated by many things including damage directly to the blood vessel, tissue damage outside of the blood vessel, hypoxia, sepsis, malignancy and inflammation.
Which factor do both the intrinsic and extrinsic pathways lead to in order to start the common pathway?
Factor 10
What are the 2 key components in the common pathway and what is their role and clothing number?
- Fibrin = traps the platelets and is Clotting Factor I
- Thrombin = activates almost everything and is Clotting Factor II
What type of anticoagulant is Warfarin?
What is the function of Warfarin and what clotting factors does it affect?
Warfarin is a vitamin K antagonist
Warfarin blocks the function of vitamin K - clotting factors 2, 7, 9 and 10.
If anticoagulant drugs end in ‘an’ what does this indicate?
What is the function of dabigatran?
What is the function of Rivaroxaban, Apaxiban, Edoxaban?
They are Non-Vitamin K Oral Anticoagulants (NOACs)
Dabigatran - direct thrombin inhibitor
Rivaroxaban, Apaxiban, Edoxaban - direct inhibitors of activated factor X
What is Haemophilia?
What drug should be avoided in Haemophilic patients?
What type of LA injection is the most dangerous in haemophilic patients?
Haemophilia is a mostly inherited disorder that impairs the body’s ability to make blood clots
Aspirin should be avoided
ID blocks can be very dangerous
What is Von Willebrand’s Disease?
Hereditary bleeding disorder - deficiency in vWF - component of Clotting Factor VIII
List 2 acquired Bleeding disorders:
- Liver Disease
- Vitamin K deficiency/Warfarin overdose
What is Systemic lupus erythematosus (SLE) characterised by?
Malar rash
List 5 association of rheumatoid Arthritis to Dentistry:
- Sjogren’s syndrome
- Patients present with dry eyes and dry mouth
- Limited opening - TMJ involvement
- Crepitus - popping/clicking of joint
- Stiffness and Pain
What is Sjogren’s syndrome?
List 3 oral manifestations of Sjogren’s syndrome:
Sjogren’s syndrome - autoimmune disease. body attacks fluid-secreting glands i.e., saliva, tears
Oral manifestations:
1. Dry eyes and mouth
2. Ulcerations
3. Parchment-like mucosa
What is scleroderma?
List 5 relations to dentistry:
Scleroderma = progressive scarring from increased collagen deposition connective tissues
Relations to dentistry:
1. Restricted opening - ‘fish mouth’
2. Dysphasia
3. Widening of periodontal ligament
4. Trismus
5. OH difficulties - use of hands
What is Tuberculosis?
What is the main oral manifestation?
TB - bacterial infection
Oral Manifestations:
1. Painful ulcer on middle of tongue or any region which angulates and has overhanging margins
What is COPD?
List 3 things which relate to dentistry:
COPD - Chronic Obstructive Pulmonary Disease
Relations:
1. Dental treatments can trigger airway problems
2. Cannot be laid back in chair
3. Difficult to use rubber dam
What is lichen planus?
What does this present like?
Lichen planus - skin disorder
Presents as bilateral white striations papules or plaques on buccal mucosa, tongue, gingiva, lips
What is Desquamative gingivitis?
What is this a symptom of?
How is this treated?
Desquamative gingivitis - red, inflamed, smooth gingiva
Symptoms of lichen planus, MMP and pemphigus vulgaris
Treated using topical corticosteroid gel or mouth rinse
How does oral EM present?
How does Minor EM present?
How does Major EM present?
Oral EM - macules which evolve to blisters and ulcers. The lips become swollen, cracked, bleeding and crusted
Minor EM - only effects one site
Major EM - e.g. Stephens-Johnson syndrome normally effect the mouth and several areas including eyes, larynx, oesophagus, genitals
What is Pemphigus Vulgaris?
What does this present?
P. Vulgaris = incurable, autoimmune blistering disorder caused by autoantibodies against parts of the epidermis
Presents:
Surface level blistering - painful and can become infected
Bullae - big, blister-like skin lesions
PAINFUL
What is pemphigoid?
How does it present?
Pemphigoid - incurable, autoimmune disorder characterized by autoantibodies against the connections between epidermal cells.
Presents:
Deep tissue blistering
Bullae - big, blister-like skin lesions
Usually PAINLESS
What is psoriasis?
Which areas of oral cavity can be affected?
Psoriasis = Common relapsing inflammatory skin disease
Can affects lips, tongue, palate, buccal mucosa.
List 4 oral manifestations of Diabetes:
Oral Manifestations:
1. Dry mouth
2. Compromised periodontal health
3. Poor wound healing
4. Sialosis - salivary gland swelling
How are gums affected when sex hormones begin to change?
How is this managed?
Swollen interdental papillae and tendency for gums to bleed
Management:
1. Scaling and polishing
2. Good OH
What are epulides?
List 4 types of epulides:
How to manage?
Epulides = solid swelling on the gum
Types:
1. Pregnancy epulides
2. Fibrous
3. Giant cell
4. Carcinomatous
Management:
Good OH and potential excision
What is Adrenocortical disease?
How does this present in oral cavity?
Addison’s disease - deficiency in adrenal gland secretion
Presents - increase in oral pigmentation
How do the following present in relation to dentistry?
1. Fallot’s tetralogy
2. Angina
3. Cyanosis
4. Hypertension
- Fallot’s tetralogy - blue lips
- Angina - toothache, particularly lower left quadrant
- Cyanosis - abnormal bluish discolouration in the skin
- Hypertension - florid facial appearance - more prone to strokes
What is the most distinguishable feature of fungal HIV and how does it respond when wiped with gauze?
What will patients typically complain of?
How is this treated?
Multiple white to yellow plaques that can be easily removed by gauze
Patients will complain of dry mouth, loss of appetite or food doesn’t taste the same
Treated with antifungal medication
List 4 viral lesions in HIV:
Can viral HIV white lesions be removed by gauze?
- Oral hairy leukoplakia
- Herpes simplex
- Varicella-zoster
- HPV
Viral HIV white lesions CANNOT be removed by gauze
What oral complication is associated with bacterial HIV?
What can be the early bacterial manifestation of HIV?
Bacterial HIV - associated gingivitis/periodontitis
Early bacterial HIV manifestation = Linear Gingival Erythema (LGE)
What type of ulceration is seen with HIV?
Crater type ulcers on mucous membrane
List 2 tumour-forming conditions associated with HIV:
- Kaposi’s sarcoma
- Lymphoma
