Systemic disease and the mouth / OFG Flashcards
What 2 types of manifestation of systemic disease on teeth?
- Disruption of the tooth structure formation
- Disruption to the tooth structure content
What two congenital conditions or infection can cause disturbance of the tooth structure?
- Syphilis , TORCH
- Ectodermal dysplasia
What are two substances causes tooth pigmentation if found in the blood?
- Bilirubin
- Tetracycline
What causes this?
Ectodermal dysplasia
What causes this?
Syphilis
What causes this?
Perinatal illness
What causes this?
A metabolic disease called porphyria
What causes this?
Bilirubin
What causes this?
Tetracycline
5 mucosal effects that may be caused from systemic disease ?
- Giant cell granulomas
- Orofacial granulomatosis
- Recurrent apthous ulceration
- Dermatoses
What are the two types of giant cell lesions?
- Central and peripheral
Which blood test is important to carry out for giant cell lesions and why?
- Parathyroid test and calcium level as giant cell lesions could be a result of hypepararthyroidism leading to stimulation of osteoclasts
Other hyperthyroidism and trauma , give 3 conditions that may be a part in causing giant cell lesions
- Renal Failure
- Hypocalcaemia
- parathyroid tumour
What is this pigmentation caused by?
Addison’s disease leading to raised ACTH
What are 3 effects of haematinic deficiencies?
- ulceration and painful tongue
The presence of which protein is a good predictor of Crohn’s disease?
Faecal calprotectin
What dietary allergens may cause OFG?
- Benzoate
- Sorbate
- Cinnamon
- Chocolate
In which food is benzoates found?
Tomatoes
How would you determine the dietary trigger to investigate OFG?
Dietary exclusion
3 management options for orofacial granulomatosis?
- 3 months empirical dietary exclusion
- Topical treatment to angular cheilitis ( miconazole , hydrocortisone cream)
- topical treatment to lip swelling (tacrolimus)
4 connective tissue diseases (autoimmune) that can have implications on the oral cavity?
- Systemic lupus erythematosis
- Systemic sclerosis
- Sjogren’s syndrome
- Mixed connective tissue disease
4 Signs of SLE in the mouth?
- Ulcers
- Angular cheilitis
- Dry mouth
- Gingivitis
What is scleroderma (systemic sclerosis)?
An autoimmune disease characterised by hardening of the skin and the connective tissues, may attack the salivary glands causing dry mouth
An example of large vessel disease
Temporal artritis
An example of medium vessel disease?
- Kawasaki disease
- Polyarteritis nodosa
An example of a small vessel disease?
- Granulomatosis with polyangitis
4 things that may cause haematinic deficiency
- Poor intake - dietary analysis
- Malabsorption - coeliac and Crohn’s disease
- Blood loss - Crohn’s disease , Ulcerative Colitis , Peptic disease , liver disease and bowel cancer
- Increased demand - childhood growth spurts
Oral effects of medical therapy
- Dry mouth
- Oral ulceration
- Lichenoid reaction
- Angio-oedema
- Osteonecrosis
Define orofacial granulomatosis?
- Clinical presentation of oedema in the oral and facial tissues due to blockage in lymphatic drainage due to an immune reaction
What is angio-oedema ?
Oedema of the oral and facial tissues due to an increase of fluid exudate from the capillaries but with no lymphatic drainage
What is the difference between OFG swelling and angio-oedema swelling?
Angio-oedema swelling comes up quickly and settles quickly whereas OFG swelling comes up quickly and settles slowly with changes in swelling intensity
What other diseases that can cause giant cell that may present as OFG?
- Crohn’s is the most common
- Tuberculosis
- Sarcoidosis
What is this?
Angio-oedema
1 histological sign in angio-oedema?
- fluid within connective tissue bundles
1 histological sign of OFG?
Giant cells
What type of hypersensitivity reaction in angio-oedema?
1- caused by allergy
What type of hypersensitivity reaction in OFG?
Type IV - a delayed hypersensitivity reaction
What are multinuclear giant cells?
Fused macrophages
How can sever OFG affect the life of a patient?
- Issues with appearance at a very important part of child development
- Often will lead to depression and isolation
What do you measure in a child with OFG to monitor growth and if abnormality is detected , what would that imply?
- Height and weight
- Abonrmality implies nutritional deficiency which imply there is bowel problem
two ways to detect if there there is a connection between OFG and Crohn’s other than the presence of faecal calprotectin?
- GI symptoms
- Start sequential growth monitoring
What interlesional steroid that can be injected to treat Crohn’s ?
- Triamcinolone
What systemic treatment other than azathioprine and prednisolone can be used in severe OFG?
Azithromycin
