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HUMAN HEALTH AND DISEASE > Oral manifestations of systemic disease > Flashcards

Oral manifestations of systemic disease Flashcards

1
Q

Which lymph nodes should you always examine extra-orally?

A

Remember extra-oral examinations begins the moment the patient walks through the door.

  1. Submental
  2. Submandibular
  3. Cervical chain
  4. Supraclavicular
  5. Occipital
  6. Post auricular
  7. Pre auricular

slide 7 and 8

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2
Q

Which areas should you always examine intra-orally?

A

-Gingiva
-Mucosa
-Lips
-Vestibule
-Hard palate
-Floor of mouth
- Ventral and lateral border of the tongue

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3
Q

Why might teeth be abnormally coloured?

A
  • Tetracycline used in odontogenesis might make them yellow, brown or grey
  • Fluorosis (opaque white or brown patches)
  • Severe long term/childhood jaundice (yellow or greenish)
  • Porphyria, a rare hereditary disorder of Hb metabolism (purplish red colour)
  • Dentinogenesis & osteogenesis imperfecta, hereditary conditions influencing mineralised tissues can manifest in mouth (purplish/brownish discolourations)
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4
Q

What is dental hypoplasia?

A

When enamel has not formed properly/correctly

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5
Q

When might dental hypoplasia occur and what would the classic manifestations of ongoing disease be?

A

In congenital syphilis

Once the child is born, the manifestations would include notched & peg-shaped permanent incisors & molars may also be deformed (Moon’s molars

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6
Q

What can cause enamel/dental hypoplasia?

A
  1. Severe childhood fevers
    - Horizontal grooves or pits
    -Especially in the incisors
  2. Severe fluorosis
    - Rough pitting, white/brown
    - Opacities
  3. Severe rickets
    - Grooving or pitting of the enamel
    - Due to low vitamin D so calcium absorption is affected
  4. Hypoparathyroidism
    - Ectodermal defects (grooving/pitting of enamel)
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7
Q

Which systemic conditions can abnormal loss of tooth surfaces reflect?

A
  1. Erosion (due to intrinsic or extrinsic acids)
  2. Attrition - bruxism
  3. Abrasion - components of diet

(Look at picture)

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8
Q

How might anaemia present orally in terms of discolouration?

A

Pallor, bleeding to palate of mucosa, red beefy sore tongue

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9
Q

What might unusual pigmentation on the oral mucous membrane, usually that of a brown melanin type pattern represent?

A

Either ethnicity or Addison’s disease

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10
Q

How might CVD & respiratory disease present orally?

A

Blue pigmentation due to cyanosis

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11
Q

How might jaundice present orally?

A

Yellow tint (have to take it seriously because it might be haemolytic, obstructive hepatic or viral, infectious hepatitis)

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12
Q

Why might the oral mucosa go white?

A

Keratosis (maybe because of trauma, mucosal disease, candida or cancer)

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13
Q

What can blue/brown tinges at the gingival margin indicate?

A

Heavy metal poisoning (lead/bismuth)

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14
Q

What might a blue/brown patch elsewhere on the oral mucosa represent?

A

Melanoma, amalgam tattoo or silver sulphide from degradation products of an old silver point RCT

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15
Q

What conditions might purpura or gingival/mucosal bleeding be indicative of?

A

Purpura:
-Acute leukaemias and HIV/AIDS
Iatrogenic – Steroids,
-May be subcutaneously and sub-mucosally
-Excessive gingival bleeding may be a feature
-Myelodysplasias – megakaryocytes fail in dysplastic marrows – low platelets

Disorders of clotting…
-Excessive gingival bleeding may be a feature
-Anticoagulant excess
-Purpura is not present
-(haemophilia A is the most important cause) - Don’t forget HaemophiliaB & von Willebrand’s Disease

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16
Q

What conditions might acute gingivitis reflect?

A

Acute leukaemia
immunodeficiencies
AIDS
Agranulocytosis
Uncontrolled diabetes
Scurvy (vitamin c deficiency)
Pellagra (Vit B3 deficiency, v rare)

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17
Q

What 3 main drug causes is gingival hyperplasia usually related to?

A

Nifedipine

Cyclosporin

Phenytoin

(always consider leukaemias)

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18
Q

What can stomatitis (ulcerations) be indicative of?

A

Apthous Ulceration:
-RAS – Major – Minor – Herpetiform
-Fe, Folate, B12- Diet, GI malabsorbtion / metabolic issues

Beçhet’s Disease:
>3 episodes ROU per annum (HLA B51 link)
Genital ulceration Eye lesions
+’ve Pathergy test Skin lesions
CNS involvement (Headache, brain fog etc)
Musculo-skeletal involvement

Reactive Arthritis (Reiter’s syndrome):
Urethritis Uveitis/Conjunctivitis Arthritis & Apthous Ulceration

19
Q

What are some disorders with haematological associations that could present as stomatitis?

A

Haematinic deficiencies
Cyclic neutropenias
Leukaemias

20
Q

Which drug therapies can result in mucosal breaches and therefore stomatitis/ulcerations?

A

Cardiovascular- beta blockers, nicorandil
Oral hypoglycaemics (DM2)
Chemotherapy cytotoxins
Sulphonamides
Barbiturates
Gold
Urea

21
Q

What systemic infections can manifest in the oral mucosa & perioral tissues?

A

Measles (small white spots known as Koplick’s spots produced, not to be confused with fordyce granules which are completely normal)

Chicken pox (cutaneous rash)

Syphilis:
(primary: ulcer at innoculation site)
(secondary: snail track ulcer, widespread rash, generally feeling unwell)
(tertiary: gumma, can lead to nasal speech, Holmes Adie pupil, leucoplakia)

Herpes zoster

Herpes simplex

TB (painful, hiding ulcer)

Actinomycoses (following wisdom teeth removal, fistula forms, yellow sulphur granules)

22
Q

Which GI tract conditions could present with stomatitis?

A

Oro-facial granulomatosis
Crohn’s disease
Coeliac disease
Ulcerative colitis

23
Q

Which different conditions do oro-facial granulomatoses comprise?

A

Oro-facial granulomatoses : swelling and irritation in the mouth and face

Melkersson-Rosenthal syndrome - Labial & peri-oral swellings + facial nerve paralysis + pilcated tongue

Meischer’s syndrome - Lip swelling only

Foodstuffs hypersensitivity (type IV)

24
Q

What is coeliac disease and how can it present?

A
  • Allergy to gluten
  • Oral ulceration

-Small bowel malabsorption of many vitamins, minerals and micro-nuitrients

-Angular cheilitis (sore cracked corners of the mouth)

-Burning of the mouth

-Glossitis (inflammation of the tongue)

25
Q

What is ulcerative colitis and how can it present orally?

A

Mural inflammation in colon wall primarily
Features shallow non-granulomatous mural ulcerations & they don’t tend to form fistulas (unlike Crohn’s disease)
Oral manifestations included

26
Q

Which diseases that affect the skin can also affect the oral mucous membrane?

A

Pemphigus
Mucous membrane pemphigoid
Epidermolysis bullosa
Erythema multiforme
Lichen planus (most common)
Linear IgA disease
Dermatitis herpetiformis

27
Q

Which lupus conditions can manifest in and around the mouth?

A

The 2 images are manifestations of discoid lupus, not systemic lupus.

28
Q

What is keratosis?

A

White patch changes on the oral mucosa, can be attributed to lichen planus, lupus, immunosuppression, candidosis, renal failure, tertiary syphilis

29
Q

What might cause glossitis (inflamed/sore tongue)

A

-Anemia

-Vitamin deficiency

30
Q

What is macroglossia & what can it be associated with?

A

Enlarged tongue, can be associated with:

Hypertrophy/hyperplasia from use e.g. filling extracted tooth sites to maintain chewing

Acromegaly (late pituitary growth hormone excess)

Amyloidosis

Neurofibromatosis

Haemangioma & Hamartomas

Lymphangiomas

Neoplasia

31
Q

What is important to note about the clinical presentation of macroglossia?

A

That the tooth imprints on dorsum of tongue suggesting enlargement (white arrows) unlike lateral margin indentations (crenulations) suggesting a tongue thrusting habit

32
Q

What is amyloidosis?

A

Protein deposition in soft tissues- often tongue & renal involvement

33
Q

How do you prove a diagnosis of amyloidosis?

A

Positive staining to congo-red

You can also expect birefringence on cross polarised light microscopy

34
Q

What diagnostic criteria would prove that dry mouth is Sjogren’s syndrome?

A

-Subjective & objective Dry occular, oral & genital mucosae

-ENA (Ro60+ve) auto-antibody positive (watch for bradycardia in neonates-O&G)

-Lip gland biopsy – peri-ductal inflammation pattern

-Classical Utrasound pattern

-Watch for Lymphoma developement over time

-Manage consequences of dry mucosae – infection, caries, tooth wear, discomfort, candida overgrowth etc

35
Q

What else can cause dry mouth?

A

Drugs: beta blockers, anti-depressants, etc

Obligate mouth breathers

Anxiety states

36
Q

What is the Challacombe scale?

A

Measures clinical oral dryness

slide 55

37
Q

What variety of effects can viral immunodeficiency cause?

A

Common: Cervical lymphadenopathy, candidosis, Kaposi’s sarcoma, hairy leucoplakia

Less common: angular cheilitis, herpes simplex/zoster, venereal warts, recurrent ulcers, rapidly progressive periodontitis, histoplasmal ulcers, cytomegalovirus, lymphoma, parotitis, etc.

38
Q

What could be some symptoms of oral cancer?

A

-A sore, lump or ulcer on the lip or in the mouth that does not heal after 2 weeks

-A lump in the neck

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 period?)

-Bad breath

-Sensory & / motor loss of the face (V &/ VII involved)

-Abnormal taste in the mouth

-Swallowing difficulty (dysphagia)

-Tongue mobility / stiffness problems (hot potato dysarthria)

39
Q

What do we mean by changes in the jaw and what could this be attributed to?

A

Areas of resorption or patchy resorption & sclerosis in the jaws, which may be due to skeletal diseases & associated with changes in the blood chemistry.

Might be Paget’s disease, widespread metastases, hyperparathyroidism, Gardner’s syndrome

40
Q

What is Gardner’s syndrome?

A

GI polyps and associated findings of SOD:

-Sebaceous cysts

-Osteomas

-Desmoid tumors

polyps have higher malignancy potential

41
Q

What is the most common cause of cervical lymph node enlargement?

A

Oral sepsis

42
Q

Why else might the cervical lymph node be enlarged?

A

It may be the first sign of diseases of the reticuloendothelial system:

-Glandular fever
-Hodgkin’s disease
-Non-Hodgkin lymphoma
-Lymphocytic leukaemia
-AIDS & its prodromes
-Or metastatic disease (e.g. oral squamous cell carcinoma)

43
Q

What manifestations of the hands and arms can show signs of other conditions?

A

Rheumatoid arthritis:
2°Sjogren’s Syndrome..

Clubbing:
-chronic suppurative disease (often chest)
-liver disease
-cyanotic heart disease

CNS:
-Parkinsonism
-intention tremor – worsens when try move
-cogwheel rigidity on flex / extend
elbows

Liver disease:
-liver palms & tremor
-coagulopathies – drug handling

HUMAN HEALTH AND DISEASE (58 decks)

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