Orofacial Manifestations of CT disease & radiation

Question 1

Systemic Lupus Erythematosus (SLE): General

Answer 1

• Autoimmune dysfxn
  
  • produce abnormal auto antibodies
    
    • deposits immune complexes in tissues & organs
  • multi system inflammation
• Females→ child bearing age
  
  • F:M 7-10:1
• Mild to severe
• No remission:
  
  • Exacerbated and quiescence periods

Question 2

What parts of our body does SLE affect?

Answer 2

• Kidney
• Brain
• BVs
• Muscles
• Joints
• Eyes

Question 3

Systemic Lupus Erythematosus: Criteria

Answer 3

• Malar Rash
• Discoid Rash
• Photosensitivity
• Oral ulcers
• Arthritis
• Serositis
• Renal Disorder
• Neurological Disorder
• Hematological disorder
• Immunological disorder
• Antinuclear antibody

Question 4

SLE: Malar Rash

Answer 4

• Fixed erythema
  
  • flat or raised
• molar eminences (cheeks)
  
  • spares nasolabial fold

Question 5

SLE: Discoid Rash

Answer 5

• Erythematous raised patches w:
  
  • keratotic scaling
  • follicular plugging
• Older lesions→ Atrophic scarring

Question 6

SLE: Photosensitivity

Answer 6

• abnormal rxn to sunlight
• Skin rash
  
  • on exposed areas
• abnormal reaction to sunlight

Question 7

SLE: Oral Ulcers

Answer 7

• Oral or nasopharyngeal ulceration
• Painless

Question 8

SLE: Arthritis

Answer 8

• Non-erosive
  
  • 2 or more peripheral joints
• Tender, swollen, or effusion

Question 9

SLE: Serositis

Answer 9

• Pleuritis
  
  • pleuritic pain hx
  • rub heard by physician or
  • evidence on radiograph or CT
• Pericarditis
  
  • ECG or
  • evidence of pericardial effusion

Question 10

SLE: Renal Disorder

Answer 10

• Persistent proteinuria> 0.5 mg/day
  
  • or > 3+ on dipstick or
  • cellular casts

Question 11

SLE: Neurological disorder

Answer 11

Rule out other causes

• Seizures
• Psychosis

Question 12

SLE: Hematological Disorder

Answer 12

• Hemolytic anemia
• Leukopenia
• Lymphopenia
• Thrombocytopenia

Question 13

SLE: Immunological disorder

Answer 13

• ANti-DNA antibodies
• Anti-Sm antibodies
• (+) anti phospholipid antibodies

Question 14

SLE: Antinulcear antibody

Answer 14

• Abnormal ANA titer (antinuclear antibody)
  
  • immunofluorescent method
  • No other causes (Drug Induced Lupus)

Question 15

SLE: Oral Manifestations

Answer 15

• Erythematous Lesions w:
  
  • white plaques
  • radiating peripheral lines
• Erythema and inflammation
  
  • due to vasculitis
  • progress to ulcers
  • Lips & mucous membranes

Question 16

Salivary Gland pathology

Answer 16

• Hyposalivation
  
  • focal parotid necrosis
• Primary salivary gland lymphoma is possible

Question 17

SLE: TMJ- Clinical vs radiographic

Answer 17

• Clinical:
  
  • Locking/dislocation
    
    • tenderness to palpation
    • crepitation
    • pain when moving mandible
• Radiographic presentations: (FOES)
  
  • flattening
  • erosion
  • osteophytes
  • sclerosis

Question 18

SLE: Trigeminal Sensory Neuropathy

Answer 18

• Present initial or slowly develops overtime
  
  • facial numbness
  • paraesthesia
  • dysesthesia
  • pain
• Possible Other CN involved

Question 19

SLE: Headache

Answer 19

• Tx as primary headache
• Study: 57% of pts
  
  • Other study: No difference in HA b/w control and SLE patient

Question 20

Drug Induced Lupus: General

Answer 20

• Drugs:
  
  • Minocycline
  • hydralazine
  • procainamide
• Caucasions
  
  • Less female Predilection
• Criteria:
  
  • Fever
  • malaise
  • arthritis or arthralgia/myalgia
  • serosisits
  • rash
  • (+) anti-nuclear antibodies
• Kidneys and Brain not involved
• Tx: Stop taking offending med

Question 21

Drug Induced Lupus: Oral Manifestations

Answer 21

• Erythema/inflammation
  
  • due to vasculitis
    
    • progress to ulceration of Lips and mucous membranes
• Erythematous lesions
  
  • w/white plaques/radiating peripheral lines

Question 22

Rheumatoid Arthritis: General

Answer 22

• Chronic Systemic inflammatory disease
  
  • synovial membrane inflammation
• etiology: unknown
  
  • Viruses
  • Genetic predisposition
  • autoimmune response
    
    • produces proinflammatory Cytokines (TNF & Interleukin-1/6)
• F:M→ 3:1
  
  • onset: 25-50 years old
  • peak: 4th/5th decade

Question 23

Rheumatoid Arthitis: Inflammatory Process

Answer 23

• Proinflammatory cytokines
  
  • TNF
  • interleukin-1 & 6
• Affects articular surface of small joints in Upper and Lower Extremities
  
  • synovial tissue
  • capsule
  • tendons
  • ligaments

Question 24

Rheumatoid Arthritis: Extra-articular manifesations

Answer 24

• Pleuritis
• pericarditis
• Peripheral neuropathy
• Dry eyes
• Dry Mouth (Secondary Sjogren syndrome)
• Scleritis
• Felty syndrome w:
  
  • splenomegaly
  • neutropenia
  • recurrent infections

Question 25

Rheumatoid Arthritis: Criteria for Classification

Answer 25

meets 4 out of 7 crieria; Criteria 1-4 present for 6 weeks

• Morning Stiffness in joint
• Arthritis
  
  • 3 or more joint areas
• Arthritis of hand joints
• Symetric arthritis
• Rheumatoid Nodules
• Serum rheumatoid factor
• Radiographic changes

Question 26

Rheumatoid Arthritis: TMJ

Answer 26

• most common
• Synovial inflammation & CT degeneration
• Symptoms:
  
  • Bilateral Pain
    
    • exacerbated by function
  • Preauricular region
    
    • tender
    • swollen
  • Stiff when waking up
  • Limited ROM of mandible
  • intracapsular joint sounds (Crepitus/clicking)
  • Fibrous or bony ankylosis
• Radiographic evidence:
  
  • none at early stages
  • joint effusions
  • disc displacements
  • abnormal condyle
    
    • erosion
    • flatten
    • sclerosis
    • subchondral cysts
    • osteophytes

Question 27

Rheumatoid Arthritis: Symptoms

Answer 27

• Increased perio
• Disease progression= ⇡ destruction of condyles
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