Oral Manifestations of Systemic Disease Flashcards
what is oral ulceration
discontinuity in the oral mucosa
causes of oral ulceration
multiple local and systemic disorders
presentation of oral ulceration
solitary ulcer
multiple ulcers
causes of solitary ulcers
malignancy
infection
exclude any type of trauma - physical or chemical
describe a malignant solitary ulcer
oral squamous cell carcinoma
describe causes of an infective solitary ulcer
causes include;
TB
Tertiary syphilis - gumma-
describe an infective solitary ulcer - TB
primary or secondary infection of mycobacterium tuberculosis
describe an infective solitary ulcer - tertiary syphilis
premalignant lesion
causes of multiple ulcers
recurrent aphthous ulceration
bechets
infection
mucocutaneous disorders
exclude haematinic deficiency and GI disease
types of multiple ulcers - RAU
major
minor
herpetiform
describe multiple ulcers - RAU
most common cause
may be related to stress
describe causes of multiple ulcers - bechets
mutlisystem condition
hereditary systemic vasculitis
presentation of multiple ulcers - bechets
almost identical oral ulcers of RAU may also present with; genital ulceration uveitis erythema nodosum other systemic features
presentation of anaemia
mucosal pallor oral ulceration glossitis angular chelitis predisposition to candida disturbed taste
describe causes of multiple ulcers - infection
primary herpeiform gingival-stomatitis
describe causes of multiple ulcers - mucocutaneous disorders
lichen planus
vesiculobullos (VB) disease - pemphigus and pemphigoid
lupus erythematosus
presentation of lichen planus
bilateral
asymptomatic
can affect the skin
potentially malignant
presentation of lupus erythematous
discoid or systemic; oral manifestations; ulceration white patches red and white patches similar appearance to lichen planus
presentation of VB disease - pemphigus vulgaris
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
presentation of VB disease - pemphigoid
benign mucous membrane pemphigoid
blisters more likely to be observed
painful oral ulceration
affects mucous membrane of other organs - e.g. eye
how may GI disease cause oral manifestations
due to underlying malabsorption and consent haematinic deficiency
examples of GI diseases causing oral manifestations
Crohn’s
ulcerative colitis
peutz jeghers
gardeners syndrome
how does Crohn’s disease cause oral manifestations
oral lesions may precede abdominal symptoms - does not necessarily correlate with intestinal disease activity
presentation of oral manifestations in Crohn’s disease
cobble stoning of mucosa localised mucogingivitis linear ulceration tissue tags/polyps diffuse swelling - lips pyostomatitis vegetans
how does ulcerative colitis cause oral manifestations
reflects severity of intestinal disease - exacerbation and remission
presentation of oral manifestations in ulcerative colitis
oral ulceration
pyostomatitis vegetans
angular stomatitis
describe white patches
an oral manifestation;
may wipe off or not wipe off
describe causes of white patches that wipe off
pseudomembranous candidiasis/thrush
describe causes of white patches that don’t wipe off
trauma
epithelial dysplasia
neoplasia
chronic mucocuaneous candidiasis
consider underlying haematinic deficiency or immunosuppression
describe oral pigmentation
racial pigmentation
melanotic macules
describe cause of oral pigmentation
malignancy
smoking
Addisons’s disease
what is Addison’s dosease
excess ACTH/MSH released from pituitary in response to reduced cortisol levels
causes of xerostomia (dry mouth)
drugs
sjogre’s syndrome
radiation therapy
describe presentation of sjogre’s syndrome
dry eyes dry mouth oral manifestations; enlarged salivary glands dry mouth - increased caries depapillated tongue, fissured red dry wrinkled mucosa increased predisposition to candida
describe sjogre’s syndrome
most commonly affects females
may be primary or secondary - secondary associated with autoimmune disease
describe dental erosion
erosion of palatal surface of upper anterior teeth - pH of stomach contents can go as low as 1
causes of dental erosion
reflux
bulimia
dietary cause or previous problem
oral presentation of leukaemia
gingival enlargement petechiae mucosal bleeding ulceration infiltration by malignant cells boggy gingivae
immuno-compromised;
candida
herpes
opportunistic infection
oral manifestations of lymphoma
palpable lymph nodes
extra/intra-oral diffuse swellings
ulceration
toth migration/mobility
oral manifestations of HIV
ulceration kaposi's sarcoma HPV lesions salivary gand swelling increased risk of malignancy
