Orofacial Manifestations of CT disease & Radiation Part 2

Question 1

Sjogren Syndrome: General

Answer 1

• autoimmune disease
• Chronic inflammation of exocrine glands
  
  • lacrimal and salivary glands
• Lymphocyte infiltrate
  
  • replaces fxnal epithelium
• Females
• Enlarge major salivary gland
  
  • Parotid Gland
• 5% develop B-Cell Lymphoma

Question 2

Sjogren Syndrome: Clinical Manifestations

Answer 2

• Keratoconjunctivitis sicca
• hyposalivation
• xerotrachea
• Dry vagina

Question 3

Sjogren Syndrome: Classification

Answer 3

• Primary SS
  
  • keratoconjunctivitis sicca
  • salivary gland dysfxn (hyposalivation)
• Secondary SS
  
  • secondary to other autoimmune diseases
    
    • ex: RA, SLE, scleroderma, polymyositis

Question 4

Primary Sjogren Syndrome Criteria

Answer 4

1. (+) Anti-SSA/Ro antibody (Score=3)
2. Focal lymphocytic sialadenitis (Score=3)
   
   1. w/focus score ≥ 1 foci/4 mm² (Score=1)
3. Abnormal ocular staining ≥ 5 (Score=1)
4. Schirmers test ≤ 5 mm/5 minutes (Score=1)
5. Unstimulated salivary flow rate ≤ 0.1 ml/minute (Score=1)

Total Score of ≥ 4 = Primary SS

Question 5

Sjogren Syndrome: Oral Manifestations

Answer 5

• Xerostomia w/burning sensation on tongue
  
  • common
• Difficulty eating dry foods
• sensitive to acidic and spicy foods
• altered taste
• coughing episodes
• speech disturbances
• increase caries risk
• oral prosthesis difficulty
• Candidiasis
  
  • may affect taste and cause burning sensation

Question 6

Sjogren Syndrome: Headaches

Answer 6

• Migraines mostly
• Might be linked to Raynaud’s phenomenon

Question 7

Sjogren’s Syndrome: Salivary Gland

Answer 7

• Parotid Gland swelling:
  
  • 30-40 % tenderness or pain when eating
• Complication:
  
  • lymphoid tissue lymphoma

Question 8

Systemic Sclerosis (SSc)

Answer 8

• Aka Scleroderma
• Multisystem CT disorder
• Abnormal Fibrosis
  
  • dysfxn of skin, vasculature, internal organs
• 3 Types:
  
  • Diffuse
  • Limited
  • Localized
• Females
  
  • African Americans
    
    • more common
    • greater severity

Question 9

Systemic Sclerosis: criteria

Answer 9

• Finger Skin thickening
  
  • extends proximal to metacarpopha-langeal joint

OR→ 7 additive items

1. Skin thickening of fingers
2. Fingertip lesions
3. Telangiectasia
4. Abnormal Nail fold capillaries
5. Interstitial lung disease
   
   1. or pulmonary arterial hypertension
6. Raynaud’s phenomenon
7. SSc-related autoantibodies

Question 10

Diffuse Systemic Sclerosis

Answer 10

• Cutaneous disease of:
  
  • face
  • neck
  • trunk
  • proximal & distal parts of limbs
• Functional changes in:
  
  • Lungs
  • Kidneys

Question 11

Limited Systemic Sclerosis

Answer 11

• CREST Syndrome
  
  • thickening of the skin on
    
    • Face
    • Neck
    • Distal part of limbs
  • CREST:
    
    • Calcinosis
    • Raynaud’s Phenomenon
    • Esophageal dysmotility
    • sclerodactyly
    • Telanglectasias

Question 12

Localized Systemic Sclerosis

Answer 12

• Morphea
  
  • localized scleroderma
  • involves the:
    
    • skin
    • subcutaneous tissue
    • muscle
  • No systemic manifestation

Question 13

Systemic Sclerosis: Eitology

Answer 13

• Unknown
• Abnormal and excessive fibrosis→ All cases
  
  • leads to:
    
    • end-organ structural damage
    • dysfunction

Question 14

Systemic Sclerosis: Oral manifestations

Answer 14

• Microstomia
  
  • limited mouth opening due to fibrosis
• Mucogingival problems
• Fibrosis of:
  
  • hard palate
  • soft palate
  • tongue
• Telangiectasis
• Pigmentation of facial skin and oral mucous membranes
• Dry Mouth (Hyposalivation)
• Dry eyes
• Widened PDL space
• TMJ dysfunction
• Trigeminal Neuropathy
• ⇡ Dental Caries
  
  • hyposalivation
  • restricted mouth opening
• ⇡ PD & gingival scores
  
  • obliterative microvasculopathy

Question 15

Systemic Sclerosis: TMJ

Answer 15

• TMJ Dysfxn
  
  • Bone resorption or erosion of:
    
    • coronoid process
    • condyle
    • angle the mandible
    • Ramus
  • Fibrosis of: (-→ Limited ROM)
    
    • masticatory m.
    • Facial expression m.
    • oral and peri oral tissues
• Clinical Presentation:
  
  • articular pain and swelling
    
    • due to tendonitis and synovitis
• Radiographic changes:
  
  • angle of mandible resorption

Question 16

Systemic Sclerosis: Headache

Answer 16

• Migraine
• Greater frequency and severity vs controls