Oral manifestations of systemic disease Flashcards
What are traditional oral manifestations of systemic diseases?
- glosssitis
- candidiasis
- oral ulcerations
What is glossitis most likely caused by
- glosssitis - most likely vitamin deficiency or anaemia
what is candidiasis most likely caused by
- candidiasis - anaemia, uncontrolled diabetes, immunosuppression
what is oral ulcerations most likely caused by
- oral ulcerations - RAS, vesiculo-bullous disease, other mucocutaneous disease
what is anaemia
- Reduction of Hb levels or RBCs - decreased capacity of blood to carry oxygen to body’s tissues
what are the symptoms of anaemia
fatigue, weakness, dizziness, pallor, shortness of breath
What is the optimal Hb concentration
The optimal Hb concentration varies by sex, age, elevation of residence, smoking habits and pregnancy status
what are the most common causes of anaemia
- Nutritional deficiency: ferritin, folate, B12
- Haemoglobinopathies: infectious diseases (malaria, TB, HIV, parasitic infections)
what are the types of anaemia
- Nutritional anaemias
- Inherited anaemias
- abnormal red blood cell
examples of nutritional anaemias
- Iron deficiency
- Pernicious (takes very long time to develop): B12
- Not absorbing B12 → injections - Megaloblastic: folate
- Macrocytic = increased MCV
examples of inherited anaemias
- Sickle cell anaemia
- Fanconi anaemia
examples of abnormal red blood cells
- Haemolytic anaemia
- Aplastic anaemia
- Autoimmune haemolytic anaemia
- Macrocytic/microcytic/normocytic anaemia
Oral manifestations of anaemia (7)
- Mucosal pallor
- Epithelial atrophy
- Mucosal burning
- Taste disturbances
- Predisposition to oral candidiasis
- Recurrent aphthous like ulcers
What is orofacial granulomatosis diagnosed by?
diagnosed by exclusion and/or a clinical descriptor
What systemic diseases can orofacial granulomatosis be associated with
can be an orofacial manifesations of IBD or sarcoidosis
What type of inflammation is seen in orofacial granulomatosis
granulomatous inflammation, which is non-caseating
What are some clinical signs of orofacial granulomatosis? (8)
- orofacial swelling,
- cobblestoning
- angular cheilitis
- tissue tagging
- linear ulceration
- aphthous ulceration
- hyperplastic gingivitis
- stag horning (raised Wharton’s duct).
What are the differential diagnoses for orofacial granulomatosis? (7)
- Idiopathic
- Hypersensitivity phenomena
- Cinnamonaldehyde
- Sodium benzoates - Crohn’s
- Sarcoidosis
- Mycobacterial infection (tb and atypical)
- Melkersson Rosenthal syndrome (OFG with facial nerve palsy)
- Angioedema (generally transient but can be life threatening)
What syndrome is characterised by orofacial granulomatosis along with facial nerve palsy?
Melkersson-Rosenthal syndrome is characterized by OFG with facial nerve palsy.
What type of condition is lupus erythematosus?
Lupus erythematosus is an inflammatory condition.
What is the characteristic skin manifestation of systemic lupus erythematosus?
The characteristic skin manifestation of SLE is a butterfly rash.
What are the oral manifestations of lupus erythematosus?
- well-demarcated zone of erythema
- atrophy or ulceration surrounded by white, radiating striae
- appear similar to lichen planus (LP).
What type of disorder is rheumatoid arthritis (RA)?
Rheumatoid arthritis is an autoimmune connective tissue disorder.
What can rheumatoid arthritis be associated with and the impact of this?
Sjogren’s → xerostomia, caries, parotitis, candidiasis
What symptom do Rheumatoid arthritis suffer with
Morning stiffness, improves with movement
What are the common joint manifestations of rheumatoid arthritis?
RA typically causes symmetric polyarthritis
-shoulders, elbows, hips, spine
Temporomandibular articulation
what are the extra-oral manifestations of rheumatoid arthritis?
hand deformity, rheumatoid nodules
What are the oral implications of rheumatoid arthritis?
Hand deformity → difficulty with TB, poor OH
TMD → eating problems, soft diet needed
What are the drug-related oral side effects seen in rheumatoid arthritis treatment?
NSAIDs = lichenoid reactions
Methotrexate = ulceration
What oral medications can a GDP prescribe for pain control in rheumatoid arthritis patients?
- Control pain
- GDP can prescribe Betensol
- Prednisolone should be prescribed by OM or GMP
What is scleroderma, and what causes it?
- Autoimmune connective tissue disorder of unknown aetiology
- Collagen type I and III deposits - Multiple organ involvement
What radiographic changes can be seen in scleroderma?
Radiographic changes include widening of the PDL and erosion of the mandibular ramus.
What are the oral manifestations of scleroderma?
- Limited opening
- Difficulty in holding brush
- May be associated with Sjogren’s
