Systemic disease and the mouth / OFG

Question 1

What 2 types of manifestation of systemic disease on teeth?

Answer 1

• Disruption of the tooth structure formation
• Disruption to the tooth structure content

Question 2

What two congenital conditions or infection can cause disturbance of the tooth structure?

Answer 2

• Syphilis , TORCH
• Ectodermal dysplasia

Question 3

What are two substances causes tooth pigmentation if found in the blood?

Answer 3

• Bilirubin
• Tetracycline

Question 4

What causes this?

Answer 4

Ectodermal dysplasia

Question 5

What causes this?

Answer 5

Syphilis

Question 6

What causes this?

Answer 6

Perinatal illness

Question 7

What causes this?

Answer 7

A metabolic disease called porphyria

Question 8

What causes this?

Answer 8

Bilirubin

Question 9

What causes this?

Answer 9

Tetracycline

Question 10

5 mucosal effects that may be caused from systemic disease ?

Answer 10

• Giant cell granulomas
• Orofacial granulomatosis
• Recurrent apthous ulceration
• Dermatoses

Question 11

What are the two types of giant cell lesions?

Answer 11

• Central and peripheral

Question 12

Which blood test is important to carry out for giant cell lesions and why?

Answer 12

• Parathyroid test and calcium level as giant cell lesions could be a result of hypepararthyroidism leading to stimulation of osteoclasts

Question 13

Other hyperthyroidism and trauma , give 3 conditions that may be a part in causing giant cell lesions

Answer 13

• Renal Failure
• Hypocalcaemia
• parathyroid tumour

Question 14

What is this pigmentation caused by?

Answer 14

Addison’s disease leading to raised ACTH

Question 15

What are 3 effects of haematinic deficiencies?

Answer 15

• ulceration and painful tongue

Question 16

The presence of which protein is a good predictor of Crohn’s disease?

Answer 16

Faecal calprotectin

Question 17

What dietary allergens may cause OFG?

Answer 17

• Benzoate
• Sorbate
• Cinnamon
• Chocolate

Question 18

In which food is benzoates found?

Answer 18

Tomatoes

Question 19

How would you determine the dietary trigger to investigate OFG?

Answer 19

Dietary exclusion

Question 20

3 management options for orofacial granulomatosis?

Answer 20

• 3 months empirical dietary exclusion
• Topical treatment to angular cheilitis ( miconazole , hydrocortisone cream)
• topical treatment to lip swelling (tacrolimus)

Question 21

4 connective tissue diseases (autoimmune) that can have implications on the oral cavity?

Answer 21

• Systemic lupus erythematosis
• Systemic sclerosis
• Sjogren’s syndrome
• Mixed connective tissue disease

Question 22

4 Signs of SLE in the mouth?

Answer 22

• Ulcers
• Angular cheilitis
• Dry mouth
• Gingivitis

Question 23

What is scleroderma (systemic sclerosis)?

Answer 23

An autoimmune disease characterised by hardening of the skin and the connective tissues, may attack the salivary glands causing dry mouth

Question 24

An example of large vessel disease

Answer 24

Temporal artritis

Question 25

An example of medium vessel disease?

Answer 25

* Kawasaki disease * Polyarteritis nodosa

Question 26

An example of a small vessel disease?

Answer 26

* Granulomatosis with polyangitis

Question 27

4 things that may cause haematinic deficiency

Answer 27

* 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

Question 28

Oral effects of medical therapy

Answer 28

* Dry mouth * Oral ulceration * Lichenoid reaction * Angio-oedema * Osteonecrosis

Question 29

Define orofacial granulomatosis?

Answer 29

* Clinical presentation of oedema in the oral and facial tissues due to blockage in lymphatic drainage due to an immune reaction

Question 30

What is angio-oedema ?

Answer 30

Oedema of the oral and facial tissues due to an increase of fluid exudate from the capillaries but with no lymphatic drainage

Question 31

What is the difference between OFG swelling and angio-oedema swelling?

Answer 31

Angio-oedema swelling comes up quickly and settles quickly whereas OFG swelling comes up quickly and settles slowly with changes in swelling intensity

Question 32

What other diseases that can cause giant cell that may present as OFG?

Answer 32

* Crohn's is the most common * Tuberculosis * Sarcoidosis

Question 33

What is this?

Answer 33

Angio-oedema

Question 34

1 histological sign in angio-oedema?

Answer 34

* fluid within connective tissue bundles

Question 35

1 histological sign of OFG?

Answer 35

Giant cells

Question 36

What type of hypersensitivity reaction in angio-oedema?

Answer 36

1- caused by allergy

Question 37

What type of hypersensitivity reaction in OFG?

Answer 37

Type IV - a delayed hypersensitivity reaction

Question 38

What are multinuclear giant cells?

Answer 38

Fused macrophages

Question 39

How can sever OFG affect the life of a patient?

Answer 39

* Issues with appearance at a very important part of child development * Often will lead to depression and isolation

Question 40

What do you measure in a child with OFG to monitor growth and if abnormality is detected , what would that imply?

Answer 40

* Height and weight * Abonrmality implies nutritional deficiency which imply there is bowel problem

Question 41

two ways to detect if there there is a connection between OFG and Crohn's other than the presence of faecal calprotectin?

Answer 41

* GI symptoms * Start sequential growth monitoring

Question 42

What interlesional steroid that can be injected to treat Crohn's ?

Answer 42

* Triamcinolone

Question 43

What systemic treatment other than azathioprine and prednisolone can be used in severe OFG?

Answer 43

Azithromycin