systemic disease and the mouth Flashcards
Name 3 congenital conditions and infections with dental manifestations in children
Syphilis - can cause changes to incisors eg - Hutchison’s incisors have bulbous crowns
TORCH infections
Ectodermal dysplasia
Name 3 illnesses and metabolic disorders with dental manifestations in children
Severe childhood illness
Cancer treatments
Porphyria - change in amounts of haem and its products in the blood can be incorporated into tissues as they form - causes tooth discolouration
What pigments from subatsnaces in the blood can cause tooth discolouration and which colour?
Bilirubin - green
Tetracycline - brown/grey
What is ectodermal dysplasia?
A group of genetic disorders causing abnormalities in structures derived form the ectoderm including skin, hair, nails, teeth and sweat glands
How may perinatal illness affect teeth?
Can cause changes to laying down and calcification of tooth tissue according to the time the illness took place
Will affect different teeth at different stages of development
What are 6 common oral mucosal effects from systemic diseases?
Giant cell granuloma
OFG
RAS
Dermatoses eg - lichen planus and vesiculobullous conditions
Immune deficiency/disease
Drug relations
What are giant cell lesions?
Osteoclast related lesions which may be due to local irritation which produces multinucleated giant cells in order to try and remove a pathogen
In which 3 conditions are giant cell lesions common?
Renal failure
Hypoglycaemia
Parathyroid tumour
What should you do if a pt has a giant cell lesion?
Check parathyroid function - can be a result of excess parathyroid stimulation of osteoclasts
How may hyperparathyroidism manifest dentally?
Loss of lamina dura - will return once parathyroid is corrected
Which 2 conditions will you find raised ACTH and how may this manifest dentally?
Addison’s and Cushing’s disease
Causes pigmentation, producing reactive melanosis of the oral mucosa
If widespread pigmentation, refer to GP
Give 3 examples of immune conditions with dental manifestations?
OFG
Sjögren’s
Addison’s and Cushing’s
Give 2 examples of skin immune diseases with dental manifestations
Lichen planus
Vesiculobullous diseases
What are the dental manifestations of haematinic deficiencies?
Oral ulceration and painful tongue
Aphthous ulceration will be enhanced if low iron due to internal bleeding into gut, poor diet or malabsorption
Name 4 signs of OFG
Peri-oral erythema and swelling
Lip swelling
Angular cheilitis
Proliferative, erythematous, full thickness gingiva
Give 4 examples of autoimmune connective tissue diseases
Systemic lupus erythematosus (SLE)
Systemic sclerosis (scleroderma)
Sjögren’s’ syndrome
Mixed connective tissue disease (MCTD)
How does lupus present?
Similar to lichen planus histologically and clinically
Desquamative gingivitis appearance
Difference found by immunology assays of the blood
How does systemic sclerosis present and what should be done dentally?
Abnormal growth leads to fibrosis (hardening) of the skin and internal organs
Can make dentistry very difficult - plan years before condition progresses with restorative consultant
Give examples of vasculitic connective tissue diseases
Large vessel disease:
- Giant cell (temporal) arteritis
Medium vessel disease:
- Polyarteritis nodosa
- Kawasaki disease
Small vessel disease:
Wegener’s Granulomatosis - most likely to have oral manifestations
What is the cause of congenital immune deficiency
Due to failure of T cell or B cell development
What 4 can relate to acquired immune deficiency?
Diabetes
Drug therapy
Cancer therapy
HIV (viruses)
What is immune deficiency most associated with and give an example of this?
Oral opportunistic infections eg - Sjögren’s syndrome causing dry mouth which then leads to a candidal infection
What is hairy leukoplakia on the lateral border of the tongue an uncommon manifestation of?
HIV
Give 4 reasons for haematinic deficiencies
Poor intake
Malabsorption due to GI diseases - Coeliac, Crohn’s
Blood loss - Crohn’s, ulcerative colitis
Increased demand - child growth spurts
Name 5 oral effects of medical therapy
Dry mouth
Oral ulceration
Lichenoid reaction
Angio-oedema eg - ACE inhibitors
Osteonecrosis - bisphosphonates
What is angio-oedema?
Rapid swelling of the face
Often due to poor regulation of the complement cascade caused by inhibition of the controlling enzymes as a side effect of ACE inhibitor use
Clinical appearance similar to OFG however, will often subside within an hour and be gone within 24 hours
