Oral Manifestations Of Systemic Disease Flashcards
What are the two ways of making a diagnosis?
What we see and hear
Medical history and examination
Extra oral examination
Extra oral examination inside mouth
How do teeth indicate systemic disease ? Abnormal colour
Tetracycline = yellow to brown or grey
Fluorosis = opaque white or brown patches
Severe / childhood jaundice = yellow or green
Porphyria = (rare hereditary disease of haemoglobin metabolism) purplish red
Dentinogenesis Imperfecta / Osteogenesis Imperfecta = purplish or brownish but INCREASED TRANSLUCENCY
What can cause Dental Hypoplasia?
(Underdevelopment)
(5)
- Congenital syphilis
- Severe childhood fevers
- Severe fluorosis
- Severe rickets
- Hypoparathyroidism
Congenital syphilis - dental hypoplasia?
– Notched and peg-shaped permanent incisors
– Molars may also be deformed (Moon’s molars)
Severe childhood fevers - dental hypoplasia?
– Horizontal grooves or pits
– particularly of the incisors
Severe fluorosis - dental hypoplasia?
– Rough pitting, white / brown
– opacities (very high fluoride areas
– eg Yemen / Sudan etc)
Severe rickets - dental hypoplasia?
– Grooving or pitting of the enamel
Hypoparathyroidism - dental hypoplasia?
– Ectodermal defects
– (grooving / pitting of enamel)
What causes abnormal loss of tooth surfaces?
1) Erosion - Extrinsic acids – (diet)?
Intrinsic acid – (gastric)?
– risk of oesophageal metaplasia and malignant conversion
– Typical in reflux disease
– heartburn
– Bulimia nervosa… (look for calloses on dorsum of digits)
2) Attrition - bruxism / TMJD / general emotional wellbeing?
3) Abrasion - components of diet / other device intra orally eg mouthpiece of wind instrument etc?
Look at reflective qs from PowerPoint 1
How does colour of mucous membranes indicate systemic disease?
Anaemia
Anaemia = pallor of mucus membrane + red beefy sore tongue
How does colour of mucous membranes indicate systemic disease?
Pigmentation
Ethnicity
Addisons disease
How does colour of mucous membranes indicate systemic disease?
Blue due to cyanosis
Cardiovascular disease
Respiratory disease
How does colour of mucous membranes indicate systemic disease?
Yellow tint due to jaundice?
haemolytic
obstructive hepatic
infectious
How does colour of mucous membranes indicate systemic disease?
White due to keratosis
trauma
mucosal disease
candida
cancer
How does colour of mucous membranes indicate systemic disease?
Blue / brown gingival margins
Heavy metal poisoning - lead and bismuth
How does colour of mucous membranes indicate systemic disease?
Blue / Brown patch
– melanoma
– Amalgam tatoo
– Silver sulphide – old silver point RCT
How does gingival / mucosal bleeding indicate systemic disease?
PURPURA (bleeding under skin)
- HIV/AIDS + acute leukaemias
- iatrogenic - steroids
- Myelodysplasias
- excessive gingival bleeding
DISORDERS OF CLOTTING
- anticoagulant excess
- purpura not present
- HAEMOPHILIA A is the most important cause
- von willebrand disease
- excessive gingival bleeding
EXCESSIVE GINGIVAL BLEEDING
Main causes of acute gingivitis
– Acute leukaemia,
– immunodeficiencies,
– AIDS
– Agranulocytosis
– Uncontrolled diabetes
- vitamin deficiencies - vit C - scurvy, vit B3 - pellagra
What causes gingival hyperplasia?
– Nifedipine
– Cyclosporin
– Phenytoin
Consider leukaemia
Link between stomatitis - ulceration and systemic disease
What might cause the ulcers?
Apthous Ulceration because of :
- Recurrent aphthous stomatitis
- low levels of iron, folate and B12 (haematological associations)
- diet
- GI malabsorption / metabolic issues
Beçhet’s Disease
More than three episodes of oral ulcers per year
Reactive arthritis
Drug therapies
• Cardiovascular – Beta-blockers, niocorandil
• Oral hypoglycaemics (DM2)
• Chemotherapy cytotoxics
• Sulphonamides
• Barbiturates,
• Gold
• Urea
Examples of systemic infections that affect mucous membranes - cause stomatitis
Stomatitis (inflammation of mucous membrane in the mouth)
Measles
Chicken pox
Syphilis
Herpes zoster
Herpes simplex
Tuberculosis - hiding painful ulcer
Actinomycoses – Occasionally following removal of wisdom teeth,
– fistula forms, yellow sulphur granules
Look at reflective qs from 2 + ANSWERS
GI Tract conditions that affect the mucous membranes
• Crohn’s Disease
• Coeliac Disease
• Ulcerative Colitis
Orofacial Granulomatoses
Google def - condition where patients have persistent swelling of lips, face and other areas in the mouth
Melkersson - Rosenthal syndrome – neurological -> labial & peri-oral swellings – facial (VII) nerve paralysis & plicated (folded) tongue
Meischer’s syndrome – lip swelling only
Foodstuffs hypersensitivity (type IV) – eg cinnamon/cinnamaldehydes / benzoates (ie allergy - not from lecture just for understanding )
Crohn’s disease
Sarcoidosis
What is Coeliac disease ?
Oral manifestations?
• Genetic inherited sensitivity to Gliadin component of wheat gluten….
Small bowel villous atrophy & malabsorption of many vitamins, minerals & micro-nutrients
- Oral Ulceration
- Angular cheilitis
- Burning mouth
- Glossitis
What is Ulcerative Colitis?
Oral manifestations?
• Mural inflammation in Colon wall primarily - Shallow non-granulomatous mural ulceration – unlike Crohn’s tends not to fistulate
- Haemorrhagic lesion
- Pyoderma gangrenosum
- Apthous like ulcer
- Pyostomatitis vegetans - (small patches across the mucosa)
Diseases affecting skin and mucous membranes:
– Pemphigus
– Mucous membrane pemphigoid
– Epidermolysis bullosa
– Erythema multiforme
– Lichen planus (more common)
– Linear IgA disease
– Dermatitis Herpetiformis
Lupus - 2 types?
Oral manifestations?
DLE + SLE
DLE- affects skin and mucosa
SLE - Systemic Lupus Erythematosis - Rheumatological condition, ANA positive
– Chronic inflammation flattens cheeks (butterfly rash over malar regiuons)
– developing wolf-like facial (lupine(-> Lupus) features
– Plus reticular pattern oral keratosis v similar to Lichen planus pattern clinically
What is keratosis?
What causes keratosis ?
White patches (in mouth)
Lichen planus
Lupus
Immunosuppressive
Candidosis
Renal failure
Tertiary syphilis
What is glossitis?
What causes glossitis?
Inflammation of the tongue
• Anaemia
– Most common identifiable cause
– Most frequently due to iron deficiency (iron is stored in the filliform papillae) diet, malabsorbtion
• Vitamin deficiencies - Riboflavin deficiency (B12) and pellagra (B3)
- Malabsorption syndromes Eg coeliac
What can cause an enlarged tongue?
• Hypertropy / Hyperplasia from use eg filling extracted tooth sites to maintain chewing
• Acromegaly
• Amyloidosis
• Neurofibromatosis
• Haemangioma & hamartomas
• Lymphangiomas
• Neoplasia
What is amyloidosis
• Protein deposition in soft tissues – often tongue & renal involvement
• Often a monoclonal protein Ig Light / Heavy chain (Multiple myeloma?) Beta pleated sheet protein deposition
Primary sjodrens syndrome + Secondary sjodrens syndrome
What do you need to watch out for?
What are the consequences of dry mucosa?
What drugs can cause dry mouth?
Primary - de novo occurrence (first time / no other conditions?? Unsure but googled)
Secondary - if preceded by another rheumatological condition eg rheumatoid arthritis, lupus
Dry oral, ocular and genital mucosa
Watch for lymphoma over time
Consequences of dry mucosa :
Infection
Caries
Toothwear
Candida overgrowth
Discomfort
Drugs = beta blockers, Antidepressant, chemotherapy
Oral cancer symptoms
Often there are no symptoms but when there are :
• A sore, lump or ulcer on the lip or in the mouth that does not heal after 2 weeks
• A lump in the neck
• A white or red patch on the gums, tongue or lining of the mouth
• Unusual bleeding, pain or numbness in the mouth
• Oral pain that does not go away or a feeling that something is caught in the throat
• Difficulty or pain with chewing or swallowing
• Difficulty with jaw opening
• Jaw swelling - poor denture fit
• Tooth loosening – often rapid (too fast for perio?)
• Bad breath
• Sensory & / motor loss of the face (V &/ VII involved)
• Abnormal taste in the mouth
• Swallowing difficulty (dysphagia)
• Tongue mobility / stiffness problems
How do changes in the jaw indicate systemic disease?
Areas of resorption or patchy resorption:
• Paget’s disease
• Widespread metastases
• Hyperparathyroidism
How does cervical lymph nodes indicate systemic disease?
Oral sepsis is commonest cause of enlargement
May also be first sign of diseases of the reticuloendothelial system:
• Glandular fever
• Hodgkin’s disease
• Non-Hodgkin lymphoma
• Lymphocytic leukaemia
• AIDS
Metastatic disease (eg Oral squamous cell carcinoma)
How can hands / arms indicate systemic disease?
• Rheumatoid arthritis - 2°Sjogren’s Syndrome
• Clubbing – chronic suppurative disease (often chest) , liver disease , cyanotic heart disease
• CNS – Parkinsonism
• Liver disease - liver palms & tremor , coagulopathies – drug handling
