Oral manifestations of systemic disease

Question 1

What are traditional oral manifestations of systemic diseases?

Answer 1

• glosssitis
• candidiasis
• oral ulcerations

Question 2

What is glossitis most likely caused by

Answer 2

• glosssitis - most likely vitamin deficiency or anaemia

Question 3

what is candidiasis most likely caused by

Answer 3

• candidiasis - anaemia, uncontrolled diabetes, immunosuppression

Question 4

what is oral ulcerations most likely caused by

Answer 4

• oral ulcerations - RAS, vesiculo-bullous disease, other mucocutaneous disease

Question 5

what is anaemia

Answer 5

• Reduction of Hb levels or RBCs - decreased capacity of blood to carry oxygen to body’s tissues

Question 6

what are the symptoms of anaemia

Answer 6

fatigue, weakness, dizziness, pallor, shortness of breath

Question 7

What is the optimal Hb concentration

Answer 7

The optimal Hb concentration varies by sex, age, elevation of residence, smoking habits and pregnancy status

Question 8

what are the most common causes of anaemia

Answer 8

• Nutritional deficiency: ferritin, folate, B12
• Haemoglobinopathies: infectious diseases (malaria, TB, HIV, parasitic infections)

Question 9

what are the types of anaemia

Answer 9

• Nutritional anaemias
• Inherited anaemias
• abnormal red blood cell

Question 10

examples of nutritional anaemias

Answer 10

• Iron deficiency
• Pernicious (takes very long time to develop): B12
  - Not absorbing B12 → injections
• Megaloblastic: folate
  - Macrocytic = increased MCV

Question 11

examples of inherited anaemias

Answer 11

• Sickle cell anaemia
• Fanconi anaemia

Question 12

examples of abnormal red blood cells

Answer 12

• Haemolytic anaemia
• Aplastic anaemia
• Autoimmune haemolytic anaemia
• Macrocytic/microcytic/normocytic anaemia

Question 13

Oral manifestations of anaemia (7)

Answer 13

• Mucosal pallor
• Epithelial atrophy
• Mucosal burning
• Taste disturbances
• Predisposition to oral candidiasis
• Recurrent aphthous like ulcers

Question 14

What is orofacial granulomatosis diagnosed by?

Answer 14

diagnosed by exclusion and/or a clinical descriptor

Question 15

What systemic diseases can orofacial granulomatosis be associated with

Answer 15

can be an orofacial manifesations of IBD or sarcoidosis

Question 16

What type of inflammation is seen in orofacial granulomatosis

Answer 16

granulomatous inflammation, which is non-caseating

Question 17

What are some clinical signs of orofacial granulomatosis? (8)

Answer 17

• orofacial swelling,
• cobblestoning
• angular cheilitis
• tissue tagging
• linear ulceration
• aphthous ulceration
• hyperplastic gingivitis
• stag horning (raised Wharton’s duct).

Question 18

What are the differential diagnoses for orofacial granulomatosis? (7)

Answer 18

• 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)

Question 19

What syndrome is characterised by orofacial granulomatosis along with facial nerve palsy?

Answer 19

Melkersson-Rosenthal syndrome is characterized by OFG with facial nerve palsy.

Question 20

What type of condition is lupus erythematosus?

Answer 20

Lupus erythematosus is an inflammatory condition.

Question 21

What is the characteristic skin manifestation of systemic lupus erythematosus?

Answer 21

The characteristic skin manifestation of SLE is a butterfly rash.

Question 22

What are the oral manifestations of lupus erythematosus?

Answer 22

• well-demarcated zone of erythema
• atrophy or ulceration surrounded by white, radiating striae
• appear similar to lichen planus (LP).

Question 23

What type of disorder is rheumatoid arthritis (RA)?

Answer 23

Rheumatoid arthritis is an autoimmune connective tissue disorder.

Question 24

What can rheumatoid arthritis be associated with and the impact of this?

Answer 24

Sjogren’s → xerostomia, caries, parotitis, candidiasis

Question 25

What symptom do Rheumatoid arthritis suffer with

Answer 25

Morning stiffness, improves with movement

Question 26

What are the common joint manifestations of rheumatoid arthritis?

Answer 26

RA typically causes symmetric polyarthritis
-shoulders, elbows, hips, spine

Temporomandibular articulation

Question 27

what are the extra-oral manifestations of rheumatoid arthritis?

Answer 27

hand deformity, rheumatoid nodules

Question 28

What are the oral implications of rheumatoid arthritis?

Answer 28

Hand deformity → difficulty with TB, poor OH
TMD → eating problems, soft diet needed

Question 29

What are the drug-related oral side effects seen in rheumatoid arthritis treatment?

Answer 29

NSAIDs = lichenoid reactions
Methotrexate = ulceration

Question 30

What oral medications can a GDP prescribe for pain control in rheumatoid arthritis patients?

Answer 30

• Control pain
• GDP can prescribe Betensol
• Prednisolone should be prescribed by OM or GMP

Question 31

What is scleroderma, and what causes it?

Answer 31

• Autoimmune connective tissue disorder of unknown aetiology
  - Collagen type I and III deposits
• Multiple organ involvement

Question 32

What radiographic changes can be seen in scleroderma?

Answer 32

Radiographic changes include widening of the PDL and erosion of the mandibular ramus.

Question 33

What are the oral manifestations of scleroderma?

Answer 33

• Limited opening
• Difficulty in holding brush
• May be associated with Sjogren’s