Systemic disease and the mouth

Question 1

What are the 3 main groups when considering Oral manifestations of systemic disease?

Answer 1

• Dental manifestations of systemic disease
• Mucosal effects of systemic disease
• Oral effects of treatment of systemic disease

Question 2

What are the 2 broad categories that dental manifestations of systemic disease occur?

Answer 2

• Disruption to tooth structure formation
• Disruption to tooth structure content

Question 3

Is dental manifestations going to be more apparent in children or adults?

Answer 3

• Children
• Apparent in primary teeth for pre/perinatal issues
• Apparent in permanent teeth for perinatal/childhood issues

Question 4

What are some congenital conditions/infections that can cause dental manifestations in children?

Answer 4

• Syphillis
• TORCH
• Ectodermal dysplasia

Question 5

What is TORCH infection?

Answer 5

• Infection of developing fetus or newborn that can occur in utero, during delivery or after birth
• Stands for toxoplasmosis, rubella, cytomegalovirus, herpes and other agents

Question 6

What is ectodermal dysplasia?

Answer 6

• Dsiorders that affect skin, sweat glands, hair, teeth and nails
• Can also cause immune system problems like hearing and vision

Question 7

What are some illness’ or metabolic disorders that can cause dental manifestations in children?

Answer 7

• Severe childhood illness
• Cancer txt (the earlier the txt starts the more dental development issues can be seen)

Question 8

What are some pigmentations from substances in the blood which can cause dental manifestations in children?

Answer 8

• Bilirubin (found in high levels in pt with jaundice can affect the teeth)
• Tetracycline (administered within antibiotic can then be incorporated iinto tooth substance)

Question 9

What systemic disease can manifest as this picture?
- Describe what you see

Answer 9

• Ectodermal dysplasia
• Shows hypodontia and hypoplasia
• Small cone shaped teeth and missing teeth
• This pt does not have full ectodermal dysplasia as has hair on upper lip

Question 10

What is a common finding of pt with ectodermal dysplasia?

Answer 10

• Absence of sweat glands or salivary glands
• Can cause issue with xerostomia - caries - perio - etc

Question 11

What systemic infection can cause this manifestation?
- Describe what you see

Answer 11

• Syphilis
• Show changes to incisors in particular termed Hutchinson’s incisor with a bulbous crown

Question 12

What systemic disease can cause this dental manifestation?
- Describe what you see

Answer 12

• Perinatal illness
• Shows chnages to the laying down to dentine and enamel
• Shows some changes to the calcification of these tissues according to the time at which the illness happened
• Give away is the Clearly same effect through different teeth
• Upper incisors formed slightly more than lower incisors but both show the hypoplastic and hypomineralised enamel and dentine

Question 13

What systemic disease can cause this dental manifestation?
- Describe what you see

Answer 13

• Metabolic disease called Porphyria
• Produce a change in the amount of hem in the blood and can induce this into the teeth
• Can see the dark pigmentation in the tooth tissues

Question 14

What systemic disease can cause this dental manifestation?
- Describe what you see

Answer 14

• Sever jaundice as a child
• Increase the bilirubin in the blood which manifests into the tooth tissues
• Leads to yellow green change in dentition
• This case the jaundice went on for some years as all of the crown is affected with the colouring

Question 15

What tooth substance pigmentation can cause this dental manifestation?
- Describe what you see

Answer 15

• Tetracycline from drug prescription
• Produce a linear band
• Tetracycline are not recommended for children anymore for this problem

Question 16

What are the oral mucosal effects from systemic disease we need to consider?

Answer 16

• Giant cell granuloma
• Orofacial granulomatosis
• Recurrent Aphthous stomatitis
• Dermatoses
• Immune deficiency/disease
• Lichen planus (drug reactions)

Question 17

What is this a picture of?

Answer 17

• Giant cell Lesion

Question 18

What are giant cell lesions?

Answer 18

• Type of noncancerous tumour
• Can be central or peripheral lesions
• Most are osteoclast related lesions but some can be due to local irritation producing multinucleated giant cells to remove stubborn pathogen

Question 19

If a giant cell lesion is due to hormonal changes what can this be due to?

Answer 19

• Parathyroid hormone excess
• Shows active parathyroid gland not being inhibited by normal negative feedback control

Question 20

When can reactive hyperparathyroid occur and what can they cause?

Answer 20

• Can occur due to renal failure or hypocalcaemia
• Can cause giant cell lesions as a result of excess parathyroid stimulation of osteoclasts

Question 21

What radiographic changes are being seen here and what can it be a result of and why?

Answer 21

• Loss of cortical bone
• Cortical bone is the densest and has highest calcium content therefore it is preferentially removed when parathyroid hormone is trying to raise the plasma calcium level during Hyperparathyroidism

Question 22

What condition is showing these radiographic changes?

Answer 22

• Hyperparathyroidism
• Lamina dura often lost around all teeth and along the whole root (don’t mistake for pathology)

Question 23

What hormone is causing this mucosal change?

Answer 23

• Raised ACTH - Addisons or cushings (pituatory adenoma producing Excess ACHT) or small tumour in lung producing ACHT
• High ACTH produces reactive melanosis of oral muscosa
• Widespread mucosal change and can happen on the