Systemic Disease and The Mouth Flashcards
Why might someone have an immune deficiency?
Congenital immune deficiency
Acquired immune deficiency
- Diabetes
- Drug therapy
- Cancer therapy
- HIV
What intra-oral findings might suggest that someone is immune deficient?
Candidiasis.
Ulceration on keratinised tissue- suggests jerpes simplex virus reactivation.
Herpes Labialis on the lip.
Why might someone have a haematinic deficiency?
Poor oral intake
Malabsorption- GI diseases.
Blood loss- Crohn’s, UC, peptic ulcer disease
Increased demand- childhood growth spurts.
What is systemic Lupus Erythematosis?
Complex chronic autoimmune disease with multi system involvement.
What factors are involved in SLE development?
Multifactorial involving genetics, and environmental factors.
Complex interaction between environmental factors and genome to produce an epigenetic change that alters expression of specific genes that contribute to the disease developing.
Describe the pathogenesis of SLE.
Triggers cause damage to the nucleus or cytoplasm of the cells.
Leads to activation of innate and adaptive immunity, auto reactive B cell activation by T cells, cytokine dysregulation.
Immune complexes deposited into tissues leading to an autoimmune cascade and organ damage.
What are the intra-oral manifestations of SLE?
Gingival lesions similar to desquamative gingivitis but red banding does not go as high up into the buccal sulcus.
Oral ulceration.
Hyposalivation
Erosion
Burning mouth syndrome.
Lichen Planus- particularly in the palate.
Cheilitis.
What are the extra-oral manifestations of SLE?
Malar rash
Renal abnormalities- protenuria, hematuria.
Ascites
Arthritis
Anaemia
Thrombocytopenia
Lung disease
Raynaud’s.
Describe the histology of SLE.
Inflammatory infiltrate (CD4-positive T cells) found around blood vessels in the lamina propria and dermis.
Granuloma formation in the lamina propria.
Thickening of basement membrane.
What are the SLE-specific auto-antibodies?
Anti-dsDNA or anti-smith antibody.
Can also get Anti-Ro and Anti-La but these are also found in Sjogren’s.
Anti-ANA
Describe the 2019 ACR/EULAR consensus on SLE diagnosis?
The criteria groups 7 clinical and 3 immunological domains together and weights them from 2 to 10.
To be diagnosed with SLE, you need to have a total score of 10 with at least one clinical criterion.
Clinical criterion
- Constitutional- fever
- Serosol
- Renal- Class III or Class IV renal nephritis would give a score of 10, proteinuria greater than 0.5g in 24 hours.
- Neuropsychiatric- delirium, psychosis, seizure
- Musculocutaneous- oral ulcers, non scarring alopecia
- Musculoskeletal- joint involvement
- Haematological- leukopenia, thrombocytopenia, autoimmune haemolysis.
Immunological domains
- Anti-dsDNA or anti-smith antibody
- C3 or C4 complement proteins
Why might someone have hyperpigmentation on their oral mucosa?
Melanoma.
Raised ACTH- addison’s disease.
Racial features
Cushing’s
Amalgam tattoo, Chlorhexidine, coffee, red wine, tea.
Melanocytic Naevus
What is orofacial granulomatosis?
Clinical presentation of oedema in the oral and facial tissues by blockage of lymphatic drainage by granulomas due to an immune reaction.
What is the difference between angio-oedema and OFG?
Angio-oedema is due to an increase in fluid exudate and not due to blockage of lymphatics.
Swelling arises quickly and reduces quickly- within 24 hours.
OFG is due to blockage of lymphatic drainage and not an increase in fluid exudate.
Swelling arises quickly and reduces slowly.
Histologically, what does OFG look like?
Fluid accumulation within connective tissue bundles.
Giant cells forming within tissues - blocking the lymphatic system.
