Oral Manifestations of Systemic Disease

Question 1

what is oral ulceration

Answer 1

discontinuity in the oral mucosa

Question 2

causes of oral ulceration

Answer 2

multiple local and systemic disorders

Question 3

presentation of oral ulceration

Answer 3

solitary ulcer

multiple ulcers

Question 4

causes of solitary ulcers

Answer 4

malignancy
infection

exclude any type of trauma - physical or chemical

Question 5

describe a malignant solitary ulcer

Answer 5

oral squamous cell carcinoma

Question 6

describe causes of an infective solitary ulcer

Answer 6

causes include;
TB
Tertiary syphilis - gumma-

Question 7

describe an infective solitary ulcer - TB

Answer 7

primary or secondary infection of mycobacterium tuberculosis

Question 8

describe an infective solitary ulcer - tertiary syphilis

Answer 8

premalignant lesion

Question 9

causes of multiple ulcers

Answer 9

recurrent aphthous ulceration
bechets
infection
mucocutaneous disorders

exclude haematinic deficiency and GI disease

Question 10

types of multiple ulcers - RAU

Answer 10

major
minor
herpetiform

Question 11

describe multiple ulcers - RAU

Answer 11

most common cause

may be related to stress

Question 12

describe causes of multiple ulcers - bechets

Answer 12

mutlisystem condition

hereditary systemic vasculitis

Question 13

presentation of multiple ulcers - bechets

Answer 13

almost identical oral ulcers of RAU
may also present with;
genital ulceration 
uveitis
erythema nodosum
other systemic features

Question 14

presentation of anaemia

Answer 14

mucosal pallor
oral ulceration 
glossitis
angular chelitis
predisposition to candida
disturbed taste

Question 15

describe causes of multiple ulcers - infection

Answer 15

primary herpeiform gingival-stomatitis

Question 16

describe causes of multiple ulcers - mucocutaneous disorders

Answer 16

lichen planus
vesiculobullos (VB) disease - pemphigus and pemphigoid
lupus erythematosus

Question 17

presentation of lichen planus

Answer 17

bilateral
asymptomatic
can affect the skin
potentially malignant

Question 18

presentation of lupus erythematous

Answer 18

discoid or systemic;
oral manifestations;
ulceration
white patches
red and white patches
similar appearance to lichen planus

Question 19

presentation of VB disease - pemphigus vulgaris

Answer 19

oral lesions are first manifestation
oral lesion precede skin lesions by 1 year or more
painful extensive oral ulceration 
receded by blisters - rupture easily
nikolsky sign

Question 20

presentation of VB disease - pemphigoid

Answer 20

benign mucous membrane pemphigoid
blisters more likely to be observed
painful oral ulceration
affects mucous membrane of other organs - e.g. eye

Question 21

how may GI disease cause oral manifestations

Answer 21

due to underlying malabsorption and consent haematinic deficiency

Question 22

examples of GI diseases causing oral manifestations

Answer 22

Crohn’s
ulcerative colitis
peutz jeghers
gardeners syndrome

Question 23

how does Crohn’s disease cause oral manifestations

Answer 23

oral lesions may precede abdominal symptoms - does not necessarily correlate with intestinal disease activity

Question 24

presentation of oral manifestations in Crohn’s disease

Answer 24

cobble stoning of mucosa
localised mucogingivitis
linear ulceration 
tissue tags/polyps
diffuse swelling - lips
pyostomatitis vegetans

Question 25

how does ulcerative colitis cause oral manifestations

Answer 25

reflects severity of intestinal disease - exacerbation and remission

Question 26

presentation of oral manifestations in ulcerative colitis

Answer 26

oral ulceration
pyostomatitis vegetans
angular stomatitis

Question 27

describe white patches

Answer 27

an oral manifestation;

may wipe off or not wipe off

Question 28

describe causes of white patches that wipe off

Answer 28

pseudomembranous candidiasis/thrush

Question 29

describe causes of white patches that don’t wipe off

Answer 29

trauma
epithelial dysplasia
neoplasia
chronic mucocuaneous candidiasis

consider underlying haematinic deficiency or immunosuppression

Question 30

describe oral pigmentation

Answer 30

racial pigmentation

melanotic macules

Question 31

describe cause of oral pigmentation

Answer 31

malignancy
smoking
Addisons’s disease

Question 32

what is Addison’s dosease

Answer 32

excess ACTH/MSH released from pituitary in response to reduced cortisol levels

Question 33

causes of xerostomia (dry mouth)

Answer 33

drugs
sjogre’s syndrome
radiation therapy

Question 34

describe presentation of sjogre’s syndrome

Answer 34

dry eyes
dry mouth 
oral manifestations;
enlarged salivary glands
dry mouth -
increased caries
depapillated tongue, fissured 
red dry wrinkled mucosa 
increased predisposition to candida

Question 35

describe sjogre’s syndrome

Answer 35

most commonly affects females

may be primary or secondary - secondary associated with autoimmune disease

Question 36

describe dental erosion

Answer 36

erosion of palatal surface of upper anterior teeth - pH of stomach contents can go as low as 1

Question 37

causes of dental erosion

Answer 37

reflux
bulimia
dietary cause or previous problem

Question 38

oral presentation of leukaemia

Answer 38

gingival enlargement 
petechiae
mucosal bleeding
ulceration 
infiltration by malignant cells 
boggy gingivae

immuno-compromised;
candida
herpes
opportunistic infection

Question 39

oral manifestations of lymphoma

Answer 39

palpable lymph nodes
extra/intra-oral diffuse swellings
ulceration
toth migration/mobility

Question 40

oral manifestations of HIV

Answer 40

ulceration 
kaposi's sarcoma 
HPV lesions 
salivary gand swelling 
increased risk of malignancy