Oral Manifestations of systemic disease Flashcards
where is oral ulceration found?
= discontinuously in the oral mucosa
how can oral oral ulceration present?
1) solitary ulcers
2) multiple ulcers
what should you try to exclude in a solitary ulcer?
= exclude TRAUMA
- physical or chemical
how long would presence of an ulcer last if malignant?
= 3weeks
what type of cancer would should malignancy in solitary ulcers?
oral squamous cell carcinoma
- feels solid & hard
- crater in middle
- roles at edges
what is another possible cause of a solitary ulcer?
= infection
e. g. TB
- primary or secondary infection of mycobacterium tuberculosis
e.g. syphilis
what physical finding would indicate primary syphilis?
crusting lesion on the lips
what finding would you see on secondary syphilis?
= snarling tract ulcer
what is the most common cause of multiple ulcers?
= recurrent aphthous ulceration
- patient otherwise well
- stress related?
- exclude haematinic deficiency and GI disease
wha are he 3 types of recurrent aphthous ulceration?
- major
- minor
- herpetiform
what condition may be associated with multiple ulcers?
= bechets
what is bechets?
multi system condition
- hereditary systemic vasculitis
(almsot identical to oral ulcers as RAU)
what is one of the most important things to exclude in pains with ulcers and symptoms might they show?
= anaemia
Symptoms;
- mucosal pallor
- oral ulceration
- glossitis
- angular chelitis
- predisposition to candida
- disturbed taste
what is glossitis?
= red raw tongue
what sort of infection would indicate multiple ulceration?
= primary herpetiform gingivo stomatitis
e.g. herpes
what 3 diseases fall under multiple ulcers?
1) lichen planus
2) lupus erythmetosus
3) vesiculobullous disease = pemphigus and pemphigoid
wha symptoms would be associated with lichen planus?
= auto-immune skin condition
Presentation
- lace like pattern
- not painful (asymptomatic)
- bilateral
- can affect skin
- pre malignant or potentially malignant
what is associated with lupus erythematosus?
= discoid or systemic
Oral manifestations;
- ulcers
- white patches
- red & white patches
- similar to lichen planes
describe VB disease - pemphigus vulgarisms?
- oral lesions are 1st manifestations
- oral lesions precede skin lesions by 1 year or more
= painful oral ulceration
= precede by blisters (rupture easily)
= niksolky sign
describe VBdisease - pemphigoid disease?
= bening mucous membrane pemphigoid
- blisters more likely o be observed
- painful oral ulceration
- affects mucous membrane of other organs e.g. eye
describe the difference between pemphigoid and pemphigus?
Pemphigoid
= sub-epithelial bullae
Pemphigus
= intra-epithelial bullae
when can oral manifestations occur as a result of GI consequences?
1) underlying malabsorption
2) consequent haematinic deficiency
what is Crohn’s disease?
= oral manifestations in 0.5%-20% of cases
- oral lesions may precede abdominal symptoms
- do not necessarily correlate with intseinanl disease activity
what are features of Crohn’s disease?
- cobble stoning of mucosa
- localised mucogingivitis
- linear ulceration
- tissue tags/polyps
- diffuse swelling (commonly of lips)
- pyostomatiis vegetates
what is ulcerative colitis?
= oral ulceration
- pyostomatiis vegetates
- angular stomatitis
- reflects severity of intestinal disease (exacerbation and remission)
what classifies white patches?
= those that wipe off or not
white patches that do and don wipe off?
DO = usually psuedo-membranous candidieasis/thrush DONT - trauma - epithelial dysplasia - neoplasia - chronic mucocutaneous - candidiasis
what could be the cause of oral pigmentation?
- racial pigmentado
- melanotic macules
- malignancy
- smoking
- Addison’s disease
(excess ACTH/MSH released from pituitary in response to reduced cortisol level)
what is the term for dry mouth?
= xerostomia
Causes
- radiation therapy
- drugs
- sjogren’s (auto-immune condition)
wha is sjogrens syndrome?
= dry eyes and dry mouth
- commonly affects females more than males (can be primary or secondary - secondary associated with other auto-immune disease)
Oral manifestations; - large salivary glands - as a result of drug mouth; = increased caries = depapillaed tongue = red, dry, wrinkled mucosa = increased predisposition o candida
what happens in leukaemia?
= gingival enlargement = peechiae = mucosal bleeding = ulceration = infiltration by malignant cells = boggy gingiivae = presentation due to immuno-compromise; - candida - herpes infection - opportunistic infection
describe lymphomas presentation in the mouth?
= palpable lymph nodes
- extra/intra oral diffuse swellings
= ulceration
= tooth migration/mobility
wha are oral manifestations of HIV?
= ulceration = Kaposi's sarcoma = HPV lesions = salivary gland swelling = due to immuno-supression = increased risk of malignancy
LECTURE 2 - ORAL PRE-MALIGNANCY & CANCER
LECTURE 2 - ORAL PRE-MALIGNANCY & CANCER
what are the characteristics of asympomatic invasive oral cancers?
surface texture: granular or smooth
elevation: 1mm max
No ulceration
No bleeding
Not induced
what ar the risk factors for oral cancers?
- tabacco
- alcohol
- diet & nutrition
- HPV
- UVL
- Candida
- syphilis/dental facttors
what are the important carcinogenic chemicals present in tobacco smoke?
- arsenic
- cyanide
- CO
what is the recommended unit intake for alcohol a week?
14 unis a week for men and women
One uni
- half pint
- shot
- glass of wine
what is the recommended daily maximum alcohol unit for men a day?
2 unis
+ 2 days free of alcohol a week
how many units do men and women need to consume in a day in order for it to count as a binned drink?
FEMALES
= 6 unites
MALES
= 8 unites
what sort of diet makes you at risk for developing oral cancer?
low in VIt A,C and iron
what is atrophy of mucosa more susceptible to?
local carcinogen
what is oral sex associated with?
HPV 16 & 17
= oropharyngeal cancer
- viruses may come and now
- increased prevalence of age
what are high risk sites for developing oral cancer?
- soft (non-keratinising) site
e.g. ventral tongue/floor of mouth
lateral tongue - rare sites (UK)
= dorsal tongue
= hard palate
note;
- buccal mucosa (asia)
what are potentially malignant lesions?
- erythroplakia
- erythroleukoplasia
- leukoplakia
- erosive lichen planus
- sub mucous fibrosis
- dyskeratosis congenita
- sideropenic dysphagia
what are the warning signs for oral cancer?
- red/white / red & white lesions
- ulcers (exclude trauma, drugs, systemic)
- numb feeling (e.g. lip/face)
- unexplained plain in mouth or neck
- change in voice
- dysphagia
what are other orofacial manifestations of cancer?
- drooping eye lid or facial palsy
- fracture of mandible
- double vision
- blocked or bleeding from nose
- facial swelling
what 4 questions should we ask a patient with suspicious lesions present?
1) how long has the lesion been present?
2) is it painful? (pain is usually LATE manifestation of oral cancer, but would be expected if benign ulcer)
3) does patients smoke/drink..how much?
4) what colour is the lesion?
