Oral Manifestations Of Systemic Disease

Question 1

Signs of anaemia or haematinic deficiency in oral manifestations

Answer 1

• recurrent Angular cheilitis (if not caused by infections such as candida and/or staph aureus)
• recurrent aphthous-like stomatitis (‘like’ as normal aphthous stomatitis doesnt have an underlying cause)
  
  • Minor, major, herpetiform

Question 2

Crohns disease - type of IBD and its oral manifestation

Answer 2

• chronic granulomatous condition
  
  • non-caseating granulomas
• can affect any part of the GI tract - mouth to anus
• oral manifestation to direct involvement - swollen lips, angular cheilitis, oral ulceration, mucosal tags, cobblestone mucosa, stag horning of sublingual folds
• blood loss
• malabsorption

Question 3

What is Oreo facial granulomatosis (OFG)

Answer 3

• the presentation identical to oral Crohn’s disease
• questioning wether OFG is a spectrum of the disease or if they are separate disease entities
• patients diagnosed with OFG may often go on to develop Crohns disease, particularly in children so if diagnosed with OFG, bowel habits are asked for, blood tests done- anemia? Raised inflammatory markers?

Question 4

Ulcerative colitis - type of IBD and its oral manifestations

Answer 4

• blood loss can occur => anaemia and its oral manifestations
• Pyostomatitis vegetations - rare condition effecting oral mucosa, seen in IBD, particularly Ulcerative colitis
  
  • small pus end pustular lesions

Question 5

Coeliac Disease and its oral manifestations

Answer 5

• assoc. with recurrent aphthous-like stomatitis and ulcers
  
  • this is secondary to malabsorption, causing haemotinic deficiency +/- anaemia (iron and folte def.)

Question 6

When should you suspect coeliac disease?

Answer 6

• in a patient with persistent or recurrent mouth ulcers
• unexplained iron, vitamin B12, or folate deficiency that may cause anaemia; or anaemia not responding to treatment

Question 7

Diabetes and its oral manifestations

Answer 7

• acute unexplained/no predisposing factors pseudomembranous candidosis (thrush)
  
  • immunodeficiency?? Diabetes?? Should be considered
• loos like white cottage cheese that can be whipped off

Question 8

Lichen planus

Answer 8

• oral mucosa, skin, scalp, genitals, oesophagus
• ~20% patients with oral lesions have skin involvement
• ~70% patient with skin lesions have oral involvement
• erosive and non-erosive subtypes
• spectrum severity of oral disease
• oral potentially malignant disorder ~1% risk over 10 years
• can be a reaction to dental materials and medications

Question 9

What is mucous membrane pemphigoid?

Answer 9

• autoimmune condition effecting mucous membrane where antibodies from the body target the basement membrane of epithelium
  
  • oral mucosa, conjunctiva, genital mucosa, nasal mucosa, and rarely skin
• form sub-epithelial blisters beneath epithelium, breakdown to form ulcers
• conjunctival healing with scarring leads to loss of sight
  
  • must be examined by an ophthalmologist, lesions affecting the eye are often asymptomatic

Question 10

Sjögren’s syndrome and its oral manifestations

Answer 10

• rheumatology
• connective tissue disease which effects exocrine glands
  
  • causes: dry mouth and/or sore eyes
• primary Sjögren’s syndrome: Sjögren’s syndrome is the only connective tissue disease effecting the patient it is known as
• secondary Sjögren’s syndrome: found with another CT disease in particular rheumatoid arthritis

Question 11

HIV/AIDS (infectious disease) and their oral manifestations

Answer 11

• candidosis
• kaposi’s sarcoma
• hairy leukoplakia

should prompt HIV testing